This is the case of a 28-year-old male active smoker with polydrug addiction of 3-month evolution. He is referred to the ER by the emergency call service 112 with signs of dyspnea of several hour evolution, pleuritic chest pain, and 2 hemoptoic sputa. The patient says that he often uses inhaled cocaine and heroin. The patient's general state of health at the ER is not so good with signs of tachypnea, use of intercostal musculature, and SpO2 of 88% with a Venturi mask at a 50L/min flow rate. The thoracic X-ray performed revealed the presence of symmetrical bilateral pulmonary infiltrates while the CT scan with contrast revealed the presence of symmetrical bilateral damage with ground-glass opacities and alveolar condensations from the upper towards the lower lung fields (Fig. 1). On the other hand, the periphery was spared including the central region; the ground-glass opacities seen were indicative of the crazy-paving pattern (Fig. 2). Structural heart disease is ruled out, and the patient is admitted to the ICU with suspected diffuse alveolar hemorrhage due to toxic substance abuse to remain on respiratory support. The fiberoptic bronchoscopy performed confirms the suspected diagnosis.

Figure 1

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Figure 2

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