key: cord-0985530-inajdwoa
authors: Bond, Michael C.; Butler, Kenneth H.; Richardson, Adam C.; Blosser, Kelly M.
title: Chest imaging of hypersensitivity pneumonitis induced by heroin abuse
date: 2021-06-09
journal: Clin Case Rep
DOI: 10.1002/ccr3.4366
sha: ab09ed6a84e93bbeaf35a3cdf956681024cbcb41
doc_id: 985530
cord_uid: inajdwoa

Long‐term abuse of nasally inhaled substances such as heroin can result in life‐threatening hypersensitivity pneumonitis and respiratory distress. In the setting of hypoxia, a chest CTA is often necessary to see the extent of the lung involvement and to rule out pulmonary emboli.

A 49-year-old woman presented to the emergency department with dyspnea, a respiratory rate of 26 times per minute and a room air oxygen saturation of 69% after nasal inhalation of heroin. A chest radiograph ( Figure 1 ) showed bilateral patchy opacities in the lower lobes. A chest computed tomography angiogram (CTA; Figure 2 ) revealed diffuse ground-glass opacities in all five lobes of the lungs representing hypersensitivity pneumonitis. The CTA was compared to a CT chest from 2 years prior, and the groundglass opacities that were present at that time were markedly worse. The patient stabilized on bilevel positive airway pressure (BiPap) and was admitted to the Medical ICU for bronchoscopy. Her SARS-CoV-2 test was negative, and her CTA revealed no evidence of pulmonary emboli. Inhaled heroin has been documented as a known cause of hypersensitivity pneumonitis, and addiction services should be a key part of the treatment strategy as well as corticosteroids and oxygen support. 1 While the chest X-ray did show some evidence of pneumonitis, a CTA was necessary to see the full extent of the inflammatory changes and to rule out pulmonary embolism. 2 

Chronic hypersensitivity pneumonitis

HRCT patterns of drug-induced interstitial lung diseases: a review

Chest imaging of hypersensitivity pneumonitis induced by heroin abuse

U R E 2 Axial CTA chest showing increased ground-glass opacities involving all five lobes consistent with hypersensitivity pneumonitis