2005, Number 1
<< Back Next >>
Rev Med Hosp Gen Mex 2005; 68 (1)
Pulmonary and renal granulomatosis due to microcrystalline cellulose: Report of the first case in Mexico
Arrecillas-Zamora MD, Aristi-Urista G
Language: Spanish
References: 27
Page: 37-40
PDF size: 125.06 Kb.
ABSTRACT
We present the case of a 45 year-old man, drug addict who five days before his death presented dyspnea, pulmonary condensation syndrome, bilateral X-ray opacities within the lungs, hiperazotemia, proteinuria, hemoglobinuria and hematuria. He died of acute respiratory and renal failure. During the autopsy the lungs were found with interstitial and alveolar chronic inflammatory infiltrate associated with numerous, needle-shaped crystals consistent with microcrystalline cellulose. The kidneys showed a tubulo-interstitial granulomatous reaction associated with similar particles. It appears that the lesions are a consequence of the intravenous administration of drugs normally intended for oral usage because they contain non-soluble microcrystalline cellulose combined with the active principle. Since 1950 inflammatory granulomatous reactions associated with intravenous injections of drugs originally manufactured for oral usage, have been described. Tablets of numerous drugs have been macerated, suspended in water and injected intravenously. The microcrystaline cellulose is a purified non-polimerized substance that is frequently used as an excipient for tablets. Other substances commonly used in combination with active principles for tablets are talc and corn starch; if injected intravenously they can also produce granulomatous reactions. The microscopic features of this material enable it to be distinguished in a relatively easy manner.
REFERENCES
Tomashefski J, Hirsch C, Jolly P. Microcristalline cellulose pulmonary embolism and granulomatosis. Arch Pathol Lab Med 1981; 105: 89-93.
Spain DM. Patterns of pulmonary fibrosis as related to pulmonary function. Ann Int Med 1950; 33: 1150.
Kringsholm B, Christoffersen P. Lung and heart pathology in fatal drug addiction. A consecutive autopsy study. Forensic Sci Int 1987; 34: 39-51.
Arnett E, Battle W, Russo J. Intravenous injection of talc-containing drugs intended for oral use. Am J Med 1976; 60: 711-718.
Tomashefski JF, Hirsch CS. The pulmonary vascular lesions of intravenous drug abuse. Hum Pathol 1980; 11: 133-145.
Ott MC, Khoor A, Scolapio JS, Leventhal JP. Pulmonary microcrystalline cellulose deposition from intravenous injection of oral medication in a patient receiving parenteral nutrition. J Parenter Enteral Nutr 2003; 27: 91-92.
Hammar SP, Williams MG, Dodson RF. Pulmonary granulomatous vasculitis induced by insoluble particulates: a case report. Ultrastruct Pathol 2003; 27: 439-449.
Diaz-Ruiz MJ, Gallardo X, Castaner E, Mata JM, Catala J, Ferreres JC. Cellulose granulomatosis of the lungs. Eur Radiol 1999; 9: 1203-1204.
Houck RJ, Bailey GL, Daroca PJ Jr, Brazda F, Johnson FB, Klein RC. Pentazocine abuse. Report of a case with pulmonary arterial cellulose granulomas and pulmonary hypertension. Chest 1980; 77 (2): 227-230.
Lindell TD, Porter JM, Langston C. Intra-arterial injections of oral medications. A complication of drug addiction. N Engl J Med 1972; 287 (22): 1132-1133.
Zeltner TB, Nussbaumer U, Rudin O, Zimmermann A. Unusual pulmonary vascular lesions after intravenous injections of microcrystalline cellulose. A complication of pentazocine tablet abuse. Virchows Arch A Pathol Anat Histol 1982; 395 (2): 207-216.
Newell GC, Reginato AJ, Auerbach D, O’Connor CR, Nelson P: Pulmonary granulomatosis secondary to pentazocine abuse mimicking connective tissue diseases. Am J Med 1988; 85 (6): 890-892.
Lindell T, Porter M, Langston C. Intra-arterial injections of oral medications. N Engl J Med 1972; 287: 1132-1133.
Goldberg I, Bahar A, Yosipovitch Z. Gangrene of the upper extremity following intra-arterial injection of drugs. Clin Orthop 1984; 188: 223-229.
Joseph W, Fletcher S, Giordano J, Adkins P. Pulmonary and cardiovascular implications of drug addiction. Ann Thor Surg 1973; 15: 263-274.
Groth D, Mackay G, Crable J, Cochran T. Intravenous injection of talc in a narcotics addict. Arch Pathol 1972; 94: 171-178.
Farber H, Falls R, Glauser F. Transient pulmonary hipertension from the intravenous injection of crushed, suspended Pentazocine tablets. Chest 1981; 80: 178-892.
Szwed J. Pulmonary angiothrombosis caused by “blue velvet” addiction. Ann Intern Med 1970; 73: 771-774.
Waller B, Bownlee W, Roberts W. Structure-function correlations in cardiovascular and pulmonary diseases (CPC). Self-induced pulmonary granulomatosis. A consequence of intravenous injection of drugs intended for oral use. Chest 1980; 78: 90-94.
Hopkins G. Pulmonary angiothrombotic granulomatosis in drug offenders. JAMA 1972; 221: 909-911.
Lewman L. Fatal pulmonary hipertension from intravenous injection of methylphenidate (Ritalin) tablets. Hum Pathol 1972; 3: 67-70
Mariani-Constantini R, Jannotta F, Jonson F. Systemic visceral talc granulomatosis associated with miliary tuberculosis in a drug addict. Am J Clin Pathol 1982; 78: 785-789.
Robertson C, Reynolds C, Wilson E. Pulmonary hypertension and foreign body granulomas in intravenous drug abusers. Am J Med 1976; 61: 657-664.
Johnston W, Waisman J. Pulmonary corn starch granulomas in a drug abuser. Arch Pathol 1971; 92: 196-202.
Reedy JS, Kuhlman JE, Voytovich M. Microvascular pulmonary emboli secondary to precipitated crystals in a patient receiving total parenteral nutrition: A case report and description of the high-resolution CT findings. Chest 1999; 115: 892-895.
Zientara M, Moore S. Fatal talc embolism in a drug addict. Hum Pathol 1970; 1: 324-327.
Estrada-Robles U, Ramírez-Blanco A, Carranza-Acevedo J. Dependencia intravenosa a la pentazocina. Reporte de un caso. Arch Invest Med (Mex) 1974; 5 (supl 1): 261-264.