IV Madde Kullanım Bozukluğu ile İlişkili Nadir Bir Septik Pulmoner Emboli Olgusu

Year 2021, Volume: 4 Issue: 1, 23 - 26, 31.03.2021

İnan Beydilli , Aysun Bozok Muhammed Baltacıoğlu Aykut Yılmaz Fevzi Yılmaz

Abstract

Amaç: Damar içi uyuşturucu madde kullanıcıları akut ve kronik pulmoner komplikasyonlar açısından yüksek risk altındadırlar. Bu sekeller ilaçların farmakodinamik özelliklerine, intravenöz (İV) kontaminantların etkilerine veya İV uygulama yolunun komplikasyonlarına bağlı gelişebilir.

Olgu Sunumu: 35 yaşında erkek hasta Acil Servis’e ateş, göğüs ağrısı ve nefes darlığı şikayeti ile başvurdu. Çekilen toraks bilgisayarlı tomografisinde (BT) her iki akciğer parankim alanlarında en büyüğü sağ alt lob süperiorda 5 cm boyutunda olmak üzere kalın cidarlı multipl kaviter akciğer lezyonları gözlendi. Hastanın ayrıntılı anamnezinde, yaklaşık 5 ay önce sağ femoral enjeksiyon sonrası kanama nedeniyle hastaneye başvurduğu ve devamında enfekte hematom ve trombozun gözlendiği, sonrasında sağ tibia ön yüzünde nekrotik yaranın oluştuğu öğrenildi. Hastaya bu klinik ve radyolojik bulguları ile septik pulmoner emboli (PE) tanısı konuldu.

Sonuç: Septik PE nadir bir klinik durum olmasına rağmen, mortalitesi ve morbiditesi yüksek bir hastalık olması nedeniyle özellikle damar içi ilaç bağımlısı olan hastalarda ve BT'de bilateral nodül ve kaviter lezyonu olan olgularda düşünülmelidir.

Keywords

Septik pulmoner emboli, Bilgisayarlı tomografi, İV madde kullanımı

A Rare Case of Septic Pulmonary Embolism Associate with IV Substance Use Disorder

Abstract

Aim: People who inject drugs (PWID) are at increased risk for acute and chronic pulmonary complications. These sequelae may be due to pharmacodynamic properties of the drugs, effects of intravenous (IV) contaminants, or complications of the IV route of administration.

Case Report: A 35-year-old male patient admitted to Emergency Department (ED) with complaints of fever, chest pain and dyspnea. Thoracic computed tomography (CT) revealed thick-walled multiple cavitary lung lesions in the parenchyma of both lungs, with the largest measuring 5 cm being located in the superior part of the right lower lobe. Based on his medical history, it was learned that the patient was admitted to the hospital about 5 months ago due to bleeding after the right femoral injection, followed by an infected hematoma and thrombosis, and a necrotic wound on the anterior surface of the right tibia. With these clinical and radiological findings, the diagnosis of septic pulmonary embolism (PE) was made.

Conclusion: Although septic PE is a rare clinical condition, it should be considered especially in PWID patients and cases with bilateral nodules and cavitary lesions on CT, since it is a disease with high mortality and morbidity.

Keywords

Septic pulmonary embolism, Computed Tomography, IV substance use

References

• Bozkuş F, Dikmen N, Atilla N, et al. Septic pulmonary embolism, a case report. Journal of Contemporary Medicine. 2016;6:76-9.
• Hong Geun O, Seung-Ick C, Kyung-Min S, et al. Risk factors for mortality in patients with septic pulmonary embolism. J Infect Chemother. 2016;22(8):553-8.
• Rui Y, Li Z, Cuihong W, et al. Clinical characteristics of septic pulmonary embolism in adults: a systematic review. Respir Med. 2014(1);108:1–8.
• Renata RA, Edson M, Efren JF. Frequency and reliability of the reversed halo sign in patients with septic pulmonary embolism due to ıv substance use disorder. AJR Am J Roentgenol. 2020;214(1):59-67.
• Moss R, Munt B. Injection drug use and right sided endocarditis. Heart. 2003;89(5):577-81.
• de Almeida RR, de Souza LS, Mançano AD, et al. High-resolution computed tomographic findings of cocaine-induced pulmonary disease: a state of the art review. Lung. 2014;192(2):225–33.
• Rachel JC, Rendell WA, Gregory LA, et al. Septic pulmonary embolism: presenting features and clinical course of 14 patients. Chest. 2005;128(1):162-6.
• Kuhlman JE, Fishman EK, Teigen C. Pulmonary septic emboli: diagnosis with CT. Radiology. 1990;174(1):211-3.
• Iwasaki Y, Nagata K, Nakanishi M, et al. Spiral CT findings in septic pulmonary emboli. Eur J Radiol. 2001;37(3):190-4.
• Kwon WJ, Jeong YJ, Kim KI, et al. Computed tomographic features of pulmonary septic emboli: Comparison of causative microorganisms. J. Comput. Assist. Tomogr. 2007;31(3):390–4.
• Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the american heart association. Circulation. 2015;132(15):1435-86
• Long B, Koyfman A. Infectious endocarditis: an update for emergency clinicians. Am J Emerg Med. 2018;36(9):1686–92.