heroin and Eosinophilia

We present a case of a woman who had progressive shortness of breath and wheezing with a mild restrictive pulmonary function pattern. She was initially diagnosed with eosinophilic granulomatosis with polyangiitis on the basis of peripheral eosinophilia, bronchoalveolar lavage eosinophilia (47%) and surgical lung biopsy findings. Six months following her diagnosis, the patient returned because of persistent symptoms, and a second review of the lung biopsy revealed thrombotic lesions in the pulmonary vessels with polarisable foreign body materials, associated giant cell reactions and numerous eosinophil infiltrates, consistent with intravenous drug abuse. Further investigation showed that she had a history of intravenous heroin overdose, and the diagnosis of excipient lung disease was made. This case highlights the importance of expert pathological, radiological and clinical review of complex presentations and the need for a thorough medication and drug use history review.

Topics: Churg-Strauss Syndrome; Eosinophilia; Excipients; Female; Granulomatosis with Polyangiitis; Heroin; Humans; Lung Diseases

Topics: Acute Disease; Administration, Inhalation; Adult; Asthma; Eosinophilia; Female; Heroin; Heroin Dependence; Humans; Male; Narcotics

Topics: Adult; Eosinophilia; Eosinophils; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Leukocyte Count; Male; Middle Aged; Military Medicine; Time Factors

Topics: Amphetamine; Barbiturates; Cannabis; Cocaine; Codeine; Eosinophilia; Heroin; Humans; Lysergic Acid Diethylamide; Male; Mescaline; Methadone; Morphine; Substance-Related Disorders

Topics: Acute Kidney Injury; Administration, Oral; Adolescent; Alkaline Phosphatase; Amenorrhea; Amphetamine; Barbiturates; Cannabis; Child; Cocaine; Eosinophilia; False Positive Reactions; Female; Hepatic Encephalopathy; Hepatitis B; Heroin; Humans; Injections, Intravenous; Injections, Subcutaneous; Juvenile Delinquency; Lysergic Acid Diethylamide; Peptic Ulcer; Pneumonia; Pseudotumor Cerebri; Substance Withdrawal Syndrome; Substance-Related Disorders