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• W4387248438 abstract "SESSION TITLE: Diffuse Lung Disease Case Report Posters 1 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm INTRODUCTION: Excipient lung disease is an uncommon complication of injection drug use that results from intravenous injection of crushed oral tablets. These tablets contain inert fillers termed excipients, which trigger angiogranulomatous reactions in the pulmonary capillaries. CASE PRESENTATION: A 31-year-old male with medical history of T8 paraplegia due to prior motor vehicle accident complicated by chronic pain on long-term opioid therapy and neurogenic bladder with chronic indwelling urethral catheter presented to the emergency department with fever, and was found to have a catheter-associated urinary tract infection. His hospital course was complicated by recurrent fevers and associated polymicrobial bacteremia on hospital days five and nine despite catheter exchange. On hospital day twelve he developed acute respiratory failure and hypotension requiring vasopressor support. Chest imaging at that time demonstrated diffuse micronodules, as well as dilated pulmonary arteries and a dilated right ventricle. Transthoracic echocardiogram confirmed abnormal septal motion consistent with right ventricular dysfunction, with estimated pulmonary artery systolic pressure of 53mmHg. On further investigation the patient admitted to crushing and injecting oxymorphone tablets using bottled water on multiple occasions, resulting in recurrent bacteremia and excipient lung disease. DISCUSSION: Intravenous injection of crushed oral tablets can trigger angiogranulomatous reactions due to excipients, or inert fillers such as talc and microcrystalline cellulose, lodging in the pulmonary vasculature. This results in dyspnea and characteristic imaging features of diffuse centrilobular nodules corresponding to perivascular granulomas. Abrupt pulmonary hypertension can occur due to occlusion of pulmonary arteriolas by granuloma formation. Micronodular formation on chest imaging has a broad differential diagnosis; excipient lung disease is characterized by its centrilobular pattern which spares the lobular septa and fissures. CONCLUSIONS: Excipient lung disease may result from intravenous drug use. As patients are frequently not forthcoming regarding injection history and clinical manifestations are nonspecific, diagnosis requires high index of suspicion based on the clinician's familiarity with this entity and its associated radiographic findings. REFERENCE #1: Nguyen V, etal. Pulmonary Effects of IV Injection of Crushed Oral Tablets: Excipient Lung Disease. AJR 2014;203:W508-W515. DISCLOSURES: No relevant relationships by Kristin Berger No relevant relationships by Di Pan" @default.
• W4387248438 created "2023-10-03" @default.
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• W4387248438 date "2023-10-01" @default.
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• W4387248438 title "DIFFUSE MICRONODULES AND PULMONARY HYPERTENSION IN A PATIENT WITH RESPIRATORY FAILURE AND SHOCK" @default.
• W4387248438 doi "https://doi.org/10.1016/j.chest.2023.07.2118" @default.
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