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A Hitherto Unreported Pulmonary Complication in an IV Heroin User^*

^* From the Department of Internal Medicine (Drs. Bishay, Amchentsev, Saleh, Patel, and Raoof), Division of Pulmonary and Critical Care Medicine, New York Methodist Hospital, New York, NY; and the Department of Pathology (Dr. Travis), Memorial Sloan Kettering Cancer Center, New York, NY.

Correspondence to: Ayman Bishay, MD, New York Methodist Hospital, Internal Medicine/Division of Pulmonary and Critical Care, 506 6th St, Brooklyn, NY 11215; e-mail: aymanbishay{at}yahoo.com

IV heroin use is associated with several well-described complications, including noncardiogenic pulmonary edema, aspiration pneumonitis, ARDS, pneumonia, lung abscess, septic pulmonary emboli, and atelectasis. Foreign-body granulomatosis may develop when drug users inject solutions containing crushed oral tablets in which talc is used as filler and can be complicated by pulmonary fibrosis. The effects are distinct from pulmonary edema, which may occur acutely with heroin injection. We describe the case of a young female patient who was an IV heroin user who also smoked cigarettes, and presented with progressive dyspnea, hypoxia, and bilateral lung infiltrates. The final pathologic diagnosis in this case was one that had not been previously reported in IV heroin users.

Key Words: drug abuse • interstitial lung disease • lung pathology