title: Pulmonary alveolar proteinosis as a reaction to fentanyl patch smoke.
abstract: We report a patient who developed shortness of breath and systemic symptoms after starting to smoke fentanyl patches. CT scan showed ground glass centrilobular nodules, and biopsy demonstrated alveolar proteinosis. Her symptoms disappeared and her chest imaging changes largely resolved when she stopped smoking the patches. Alveolar proteinosis is an uncommon drug reaction and in this case presented in a very unusual fashion as an inhalation injury.
authors.affiliation: Department of Pathology, Vancouver General Hospital and University of British Columbia, Vancouver, BC, Canada.
authors.forename: Erin
authors.initials: E
authors.lastname: Chapman
authors.affiliation: Department of Radiology, St. Paul's Hospital, Vancouver, BC, Canada.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Leipsic
authors.affiliation: Department of Pathology, Royal Alexandra Hospital, Edmonton, AB, Canada.
authors.forename: Niranjala
authors.initials: N
authors.lastname: Satkunam
authors.affiliation: Department of Pathology, Vancouver General Hospital and University of British Columbia, Vancouver, BC, Canada. Electronic address: achurg@interchange.ubc.ca.
authors.forename: Andrew
authors.initials: A
authors.lastname: Churg
mesh_terms: D000280:Administration, Inhalation; D001706:Biopsy; D005260:Female; D005283:Fentanyl / Q000633:toxicity*; D005500:Follow-Up Studies; D006801:Humans; D058545:Inhalant Abuse / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology; D008168:Lung / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology; D008875:Middle Aged; D009294:Narcotics / Q000633:toxicity*; D011649:Pulmonary Alveolar Proteinosis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology; D020775:Thoracic Surgery, Video-Assisted; D014057:Tomography, X-Ray Computed; D057968:Transdermal Patch
chemical_list: D009294:Narcotics; D005283:Fentanyl