Published online August 21, 2006
PEDIATRICS Vol. 118 No. 3 September 2006, pp. e924-e928 (doi:10.1542/peds.2006-0085)

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EXPERIENCE & REASON

Intravenous Injection of Pharmaceutical Tablets Presenting as Multiple Pulmonary Nodules and Declining Pulmonary Function in an Adolescent With Cystic Fibrosis

Kelly J. Smith, MD^a, Okan Elidemir, MD^a, Megan K. Dishop, MD^b, Karen W. Eldin, MD^b, Nina Tatevian, MD, PhD^b and Robert H. Moore, MD^a

^a Pediatric Pulmonology
^b Pediatric Pathology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas

ABSTRACT

Here we present the unusual case of an adolescent with cystic fibrosis presenting with declining pulmonary function and diffuse micronodular pulmonary disease. This case illustrates the radiographic and pathologic findings associated with the intravenous injection and pulmonary arterial embolization of insoluble pharmaceutical-tablet constituents. The number of first-time users reporting nonmedical use of prescription pain relievers is increasing dramatically, especially in adolescents. Recognition of both the diagnostic imaging features and histologic features on lung biopsy are critical steps for early diagnosis, intervention, and potential prevention of sudden death in these at-risk patients.

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Key Words: cystic fibrosis • substance abuse • intravenous • povidone • crospovidone • microcrystalline cellulose • pathology • pulmonary disease • respiratory function tests

Abbreviations: CF, cystic fibrosis • PFT, pulmonary-function test • CT, computed tomography • TIVAD, totally implantable vascular access device

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Accepted Mar 28, 2006.

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