title: Illicit narcotic injection masquerading as acute pulmonary embolism.
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.
authors.affiliation: University of Toledo, Toledo, OH, USA.
authors.forename: Shelley A
authors.initials: SA
authors.lastname: Klochan
authors.forename: Mohammed
authors.initials: M
authors.lastname: Taleb
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Hoover
authors.forename: Vincent F
authors.initials: VF
authors.lastname: Mauro
authors.forename: Vasuki
authors.initials: V
authors.lastname: Anandan
authors.forename: James
authors.initials: J
authors.lastname: Willey
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Cooper
mesh_terms: D000208:Acute Disease; D002482:Cellulose / Q000032:analysis; D003937:Diagnosis, Differential; D005938:Glucocorticoids / Q000627:therapeutic use; D015745:Granuloma, Foreign-Body / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy; D006801:Humans; D007275:Injections, Intravenous; D008171:Lung Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D008297:Male; D009294:Narcotics / Q000009:adverse effects*; D010045:Outpatients; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy; D018805:Sepsis / Q000175:diagnosis / Q000000981:diagnostic imaging; D015813:Substance Abuse Detection; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D009294:Narcotics; D002482:Cellulose