A medical marijuana patient in California was found to have a rare life-threatening infection that was traced to her medicinal marijuana.

Bryan B Shapiro, M.D., MPH, found Cryptococcal meningitis in the patient and reported the case in the British Journal of Medicine. This life-threatening disease is normally only seen in immunocompromised individuals. The individual they diagnosed with the disease was a daily cannabis smoker but had no history of immunodeficiency.

So how did this happen? The patient's marijuana was contaminated with multiple varieties of fungus, including the pathologic Cryptococcal neoformans the patient had.

Cryptococcus neoformans can be found throughout the world, and people can become infected with this fungus after inhaling its small microparticles. It is rare to become ill from it, if healthy. Those with weakened immune systems such as HIV/AIDS, however, are vulnerable and can become ill.

This was not the first report of contaminants posing a threat to life for the patient using medicinal marijuana. Previous reports are generally in immunocompromised patients. One such patient suffered an invasive infection of the lungs with aspergillosis.

The patient discussed in the BJM was from California, but other states are also having problems with mold. Mold and yeast were identified in prerolled joints produced by Lightshade Labs, LLC, in Colorado, prompting a voluntary recall of the products. The Denver Department of Public Health and Environment (DDPHE) advised consumers to destroy the potentially contaminated products.

"DDPHE opened an investigation after receiving a complaint of illness potentially associated with these products," DDPHE announced in a statement. "Short- and long-term health impacts resulting from inhalation exposure to mold may exist depending on the specific product, duration, frequency and level of exposure. Consumers with concerns about their personal health should contact their physician with related questions."

Arizona has had reports of mold in medicinal marijuana, but unlike other states they do not have tight standards or testing. Multiple labs in Massachusetts have had concerns about mold-contaminated products as well, and the response from the dispensaries is varied.

The evolving legal marijuana industry in Massachusetts is acknowledging that the environment there, compared to the western state of Colorado, is conducive to mold and humidity. The result is likely to be even greater amounts of mold in products.

The standards for what is a tolerable level of mold and fungus, if any, are not clear. Further, the standards and methods to test for the presence of such contaminants has not yet been established. What is established is that having mold and fungus in inhaled marijuana can be toxic and potentially deadly.