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Illicit narcotic injection masquerading as acute pulmonary embolism.
Vasc Med. 2013 Apr;18(2):92-4
Authors: Klochan SA, Taleb M, Hoover MJ, Mauro VF, Anandan V, Willey J, Cooper CJ
Abstract
A 23-year-old male presented from a nursing home with hypotension, tachycardia, diaphoresis and electrocardiographic evidence of right ventricular strain that was confirmed by echocardiography. His differential diagnosis included sepsis and pulmonary embolism. A high-resolution computed tomography scan demonstrated no pulmonary emboli but did demonstrate multiple bilateral pulmonary nodules. Upon questioning he admitted to injecting a long-acting narcotic that had been manually macerated, dissolved in saline, and injected through an indwelling intravenous line. Lung biopsy findings were consistent with cellulose-induced perivascular granulomatosis. Cellulose granulomatosis can be seen in patients who inject medications designed for oral use and should be considered in patients who present with acute pulmonary hypertension.
PMID: 23493623 [PubMed - indexed for MEDLINE]