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Respiratory medicine
Excipient lung disease with transient severe pulmonary hypertension in a healthcare professional injecting crushed oxycodone tablets
  1. Matthew T Donnan1,
  2. Catriona McLean2,
  3. Miranda Siemienowicz3,4 and
  4. Dominic T Keating1,4
  1. 1 Department of Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
  2. 2 Anatomical Pathology, Alfred Health, Melbourne, Victoria, Australia
  3. 3 Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
  4. 4 Central Clinical School, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia
  1. Correspondence to Dr Dominic T Keating; d.keating{at}alfred.org.au

Abstract

Excipient lung disease (ELD) is a rare cause of pulmonary hypertension that occurs due to the intravenous injection of crushed tablets. We present the case of a healthcare professional in her late 30s who presented with a fever in the setting of a Stenotrophomonas maltophilia bacteraemia. During her hospital admission, she established a pattern of transient hypoxia and hypotension, with resolution without targeted management or clear cause identified. She developed progressive pulmonary centrilobular micronodularity on computed tomography and severe pre-capillary pulmonary hypertension. Lung biopsy revealed pulmonary arteriolar deposition of microcrystalline cellulose with an associated giant cell reaction leading to the diagnosis of ELD secondary to injection of crushed oxycodone tablets. In the setting of abstinence from intravenous drug use, the patient made a full recovery. ELD is rare and requires a high index of suspicion to diagnose. Treatment is largely supportive and should include removal of excipient exposure and addiction medicine services.

  • Pulmonary hypertension
  • Drugs misuse (including addiction)

https://doi.org/10.1136/bcr-2024-260988

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms and critical revision for important intellectual content: MTD, CM, MS, DTK. The following authors gave final approval of the manuscript: MTD, CM, MS, DTK. The following author is the guarantor: DTK.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer-review Not commissioned; externally peer-reviewed.