Pulmonary Foreign Body Granulomatosis Following Intravenous Injection of Oral Medication: A Rare Case Report

TL;DR

Injecting crushed oral medication intravenously can cause rare lung inflammation, as shown in a case report of a 62-year-old woman.

Contribution

The paper documents a rare case linking PICC line misuse to pulmonary granulomatosis, enhancing understanding of this condition.

Findings

A 62-year-old woman developed pulmonary nodules from crushed oral medication injected via PICC line.

Lung biopsy confirmed granulomatous inflammation with foreign-body giant cells.

The case highlights the risks of improper PICC line use for administering crushed oral drugs.

Abstract

Intravenous injection of pulverized tablet formulations intended for oral use may lead to pulmonary foreign body granulomatosis, a rare and serious condition. This case report details an unusual case of pulmonary micronodular disease resulting from the injection of crushed hydrocodone bitartrate and acetaminophen tablets via a peripherally inserted central catheter (PICC). A 62-year-old female on total parenteral nutrition presented with progressive dyspnea on exertion. A high-resolution CT scan revealed bilateral diffuse pulmonary nodules. Bronchoscopy and lung biopsy confirmed the presence of granulomatous inflammation with foreign-body giant cells, consistent with a foreign-body reaction. A detailed history uncovered that the patient had been administering crushed oral medication through her PICC line for better pain control. This case report adds to the literature by documenting the severe consequences of PICC line misuse and enhancing the understanding of lung granulomatous reactions from foreign materials.

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