title: Intravenous injection of pharmaceutical tablets presenting as multiple pulmonary nodules and declining pulmonary function in an adolescent with cystic fibrosis.
abstract: Here we present the unusual case of an adolescent with cystic fibrosis presenting with declining pulmonary function and diffuse micronodular pulmonary disease. This case illustrates the radiographic and pathologic findings associated with the intravenous injection and pulmonary arterial embolization of insoluble pharmaceutical-tablet constituents. The number of first-time users reporting nonmedical use of prescription pain relievers is increasing dramatically, especially in adolescents. Recognition of both the diagnostic imaging features and histologic features on lung biopsy are critical steps for early diagnosis, intervention, and potential prevention of sudden death in these at-risk patients.
authors.affiliation: Department of Pediatric Pulmonology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas 77030, USA. kjsmith@texaschildrenshospital.org
authors.forename: Kelly J
authors.initials: KJ
authors.lastname: Smith
authors.forename: Okan
authors.initials: O
authors.lastname: Elidemir
authors.forename: Megan K
authors.initials: MK
authors.lastname: Dishop
authors.forename: Karen W
authors.initials: KW
authors.lastname: Eldin
authors.forename: Nina
authors.initials: N
authors.lastname: Tatevian
authors.forename: Robert H
authors.initials: RH
authors.lastname: Moore
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage / Q000009:adverse effects; D000293:Adolescent; D003550:Cystic Fibrosis; D003937:Diagnosis, Differential; D004338:Drug Combinations; D004617:Embolism / Q000209:etiology*; D005079:Excipients / Q000008:administration & dosage / Q000009:adverse effects; D017809:Fatal Outcome; D005260:Female; D005549:Foreign-Body Reaction; D006801:Humans; D006853:Hydrocodone / Q000008:administration & dosage / Q000009:adverse effects; D007275:Injections, Intravenous; D011651:Pulmonary Artery / Q000473:pathology; D012129:Respiratory Function Tests; D003074:Solitary Pulmonary Nodule / Q000175:diagnosis*; D019966:Substance-Related Disorders / Q000175:diagnosis*; D013607:Tablets / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D004338:Drug Combinations; D005079:Excipients; D013607:Tablets; C083640:acetaminophen, hydrocodone drug combination; D000082:Acetaminophen; D006853:Hydrocodone