Intranasal Fentanyl Intoxication Leading to Diffuse Alveolar Hemorrhage.

CONTEXT: Increasing rates of opioid abuse, particularly fentanyl, may lead to more presentations of unusual effects of opioid toxicity. Diffuse alveolar hemorrhage is a rare complication of fentanyl overdose. CASE DETAILS: A 45-year-old male presented in hypoxic respiratory failure secondary to diffuse alveolar hemorrhage requiring intubation. Comprehensive drug screening detected fentanyl without exposure to cocaine. Further history upon the patient's recovery revealed exposure to snorted fentanyl powder immediately prior to presentation. DISCUSSION: Diffuse alveolar hemorrhage is a potential, though rare, presentation of opioid intoxication.
CONCLUSIONS: Recognition of less common complications of opioid abuse such as diffuse alveolar hemorrhage is important in proper management of overdoses.