Marijuana Smoking in Patients With Leukemia

Sara Khwaja, MD; Abraham Yacoub, MD; Asima Cheema, MD; Nancy Rihana, MD; Robin Russo, MD; Ana Paula Velez, MD; Sowmya Nanjappa, MBBS, MD; Ramon L. Sandin, MD; Chandrashekar Bohra, MBBS; Ganesh Gajanan, MBBS; John N. Greene, MD


Cancer Control. 2016;23(3):278-283. 

In This Article


Marijuana smoking can be dangerous and life threatening in the setting of neutropenia and T-cell immunodeficiency, although other risk factors and lifestyle practices may contribute to this pulmonary pathology. Marijuana smoking is associated with fungal pneumonia due to the possible inhalation of mold spores on the leaves of the marijuana plant. This is because marijuana cigarettes typically do not have a filter to prevent spore inhalation, which is generally in contrast to cigarettes. Marijuana can also damage the lungs and impair local lung immune responses, thus possibly predisposing those who smoke marijuana to invasive pulmonary fungal infection. Bronchiolitis may also occur in those who smoke marijuana because the small airways of the lungs may become irritated when hot smoke is inhaled — this can also occur with smoking tobacco, breathing air pollution and other types of smoke, and being exposed to chemical irritants.

The findings from this case series highlight the need to consider antifungal prophylaxis and cessation of marijuana use among patients with prolonged neutropenia and concomitant marijuana use. In addition to miliary tuberculosis and endemic mycosis, invasive fungal infections possibly related to cannabis use should also be included in the differential diagnosis of those who demonstrate a nodular pattern and represent a susceptible host.