Pulmonary Foreign Body Embolism and Granulomatosis in Intravenous Substance Abuse

Abstract

Prescription drug abuse has increased in the United States in part because of the relative ease of acquisition. Some drug abusers resort to the injection of crushed tablets for rapid onset and increased euphoria. Adolescents and young adults with chronic pain disorders and intravenous access ports are particularly susceptible to this practice. Clinically, those who inject tablets may develop dyspnea, hypoxemia, pulmonary hypertension, and are at an increased risk of sudden death. In addition to the active ingredient(s), pharmaceutical tablets contain inert excipients such as talc, starch, microcrystalline cellulose and crospovidone. Angiothrombosis and foreign body granulomatosis induced by particulate emboli are the major pathological findings identified. Tablet excipients can be discerned by their morphological and histochemical attributes. Microanalytic techniques may be required for definitive identification. Inhalational exposures, aspiration, endogenously formed crystals, and hyperalimentation are potential mimickers of tablet-induced foreign body emboli and granulomatosis.