Hossein-Zadeh Zarrin, Shuman Mark J, Rapkiewicz Amy
From the Department of Pathology, NYU Langone Health, Long Island School of Medicine, Mineola, NY.
Miami-Dade County Medical Examiner Department, Miami, FL.
Am J Forensic Med Pathol. 2022 Mar 1;43(1):81-89. doi: 10.1097/PAF.0000000000000721.
Crushed oral tablets, when injected intravenously, may induce a foreign body granulomatous reaction in and around pulmonary arterioles, because of the presence of filler materials (excipients). This typically presents as shortness of breath in the context of pulmonary hypertension with arteriolar dilation and centrilobular nodules on imaging modalities. The constellation of findings may be overlooked or misdiagnosed by clinicians and pathologists, ultimately affecting patient care and postmortem assessment. We describe 5 patients with excipient lung disease that had antemortem chronic medical conditions that required a peripherally inserted catheter or port. All 5 patients had intravascular and perivascular deposition of polarizable foreign material within the pulmonary arteries. Foreign body granulomatosis as a result of intravenous drug use was not clinically suspected in any patient, and 2 of the 5 patients were misdiagnosed with mycobacterium infections. Pulmonary congestion, dyspnea, and symptoms of heart failure were noted in 3 patients and 2 had a history of upper arm deep vein thrombosis. We conclude that excipient lung disease may be underdiagnosed cause of dyspnea, pulmonary hypertension, and death in patients with a known history of intravenous drug use.
口服片剂碾碎后静脉注射，可能会因填充材料（辅料）的存在，在肺小动脉内及周围引发异物肉芽肿反应。这在影像学上通常表现为肺动脉高压伴小动脉扩张及小叶中心结节的情况下出现呼吸急促。这些发现可能被临床医生和病理学家忽视或误诊，最终影响患者护理和尸检评估。我们描述了5例患有辅料性肺病的患者，他们生前患有慢性疾病，需要外周静脉导管或输液港。所有5例患者的肺动脉内均有可极化异物的血管内和血管周围沉积。所有患者临床上均未怀疑静脉吸毒导致的异物肉芽肿病，5例患者中有2例被误诊为分枝杆菌感染。3例患者出现肺淤血、呼吸困难和心力衰竭症状，2例有上臂深静脉血栓形成病史。我们得出结论，在有静脉吸毒已知病史的患者中，辅料性肺病可能是呼吸困难、肺动脉高压和死亡的诊断不足的原因。
