Abstract A 48-year-old male with a history of opioid dependency with progressive shortness of breath and cough. He reported snorting opioid pills for pain control and decided to add phentermine pills snorting with immediate acute worsening of symptoms. Chest CT revealed ground-glass opacities, architectural distortion, curvilinear scarring, and subpleural banding. The clinical, radiologic, and exposure history supported a diagnosis of drug-induced interstitial lung disease (DI-ILD). The Naranjo Score of 9 points was consistent with a probable reaction. This case highlights the importance of recognizing inhalational multi-drug use as a risk factor for ILD. Case Presentation A 48-year-old man with a history of opioid dependency, presented with several weeks of worsening shortness of breath and cough despite recent cessation of vaping. He described clear sputum production and chest pressure. Notably, he had been snorting opioid pills for pain control prior to presentation. Three days before presentation, he also snorted several phentermine pills, after which his respiratory symptoms acutely worsened. Physical examination revealed bibasilar crackles. High-resolution chest CT demonstrated bilateral ground-glass opacities, architectural distortion, superimposed curvilinear scarring, and subpleural banding. No evidence of infection, autoimmune disease, or environmental exposures was identified.The patient improved with cessation of snorting agents and the Naranjo score was calculated at 9 points: The reaction occurred after the drug was given, and possibly followed a pattern consistent with drug reaction that is reasonably explained as an adverse drug reaction. Discussion Numerous agents, including opioids and stimulants, can induce a spectrum of interstitial lung injury patterns, most commonly nonspecific interstitial pneumonia (NSIP), organizing pneumonia, diffuse alveolar damage (DAD) and acute eosinophilic pneumonia, among others. Inhalational exposures, such as snorting pills, are associated with increased risk of ILD, especially if designed to use orally. Meta-analyses demonstrated odds ratios for ILD ranging from 1.45 to 1.69 for various inhaled agents.Radiographically, drug-induced ILD often presents with ground-glass opacities, reticulation, and architectural distortion, as seen in this case. Histopathologic findings are generally nonspecific and overlap with other forms of ILD.Management centers on prompt discontinuation of the offending agents and supportive care. Systemic corticosteroids may be considered. Multidisciplinary discussion is recommended. This abstract is funded by: None
Klingel et al. (Fri,) studied this question.