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Case Reports: Reminder of important clinical lesson
Excipient lung disease secondary to intravenous heroin use
  1. Gretchen A Colbenson1,
  2. Aahd Kubbara2,
  3. Christian W Cox3,
  4. Eunhee S Yi4 and
  5. Misbah Baqir2
  1. 1Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
  2. 2Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
  3. 3Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
  4. 4Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Misbah Baqir; baqir.misbah{at}mayo.edu

Abstract

We present a case of a woman who had progressive shortness of breath and wheezing with a mild restrictive pulmonary function pattern. She was initially diagnosed with eosinophilic granulomatosis with polyangiitis on the basis of peripheral eosinophilia, bronchoalveolar lavage eosinophilia (47%) and surgical lung biopsy findings. Six months following her diagnosis, the patient returned because of persistent symptoms, and a second review of the lung biopsy revealed thrombotic lesions in the pulmonary vessels with polarisable foreign body materials, associated giant cell reactions and numerous eosinophil infiltrates, consistent with intravenous drug abuse. Further investigation showed that she had a history of intravenous heroin overdose, and the diagnosis of excipient lung disease was made. This case highlights the importance of expert pathological, radiological and clinical review of complex presentations and the need for a thorough medication and drug use history review.

  • Pathology
  • Radiology
  • Respiratory medicine
  • Rheumatology
  • Drugs and medicines

https://doi.org/10.1136/bcr-2021-247763

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    Footnotes

    • Twitter @GColbensonMD

    • Contributors All listed authors have contributed, read and approved the manuscript. Contributions of each author are as follows. GAC: conceptualisation, preparation of original draft and figure development; AK: review and editing (specifically to pulmonology expertise); ESY: preparation of original draft (specifically pathology expertise), review and editing, and figure development; MB: preparation of the original draft (specifically radiology expertise), figure development, and review and editing; MB: preparation of original draft (pulmonology expertise), supervision, and review and editing.

    • 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.