Dyspnea and bilateral interstitial pulmonary infiltrates in an intravenous drug user

Bradley S. Jones, MD, Frank A. Brancaccio, MD, and Gabriel A. Rodriguez, MD

From the Departments of Internal Medicine (Jones and Brancaccio) and Pathology (Rodriguez), Baylor University Medical Center, Dallas, Texas.

Corresponding author: Frank A. Brancaccio, MD, 3600 Gaston Avenue, Suite 806, Dallas, Texas 75246 (e-mail: FrankB@BaylorHealth.edu).

CASE PRESENTATION

BRADLEY S. JONES, MD: A 66-year-old man, a known intravenous heroin user for 45 years, presented to Baylor University Medical Center (BUMC) in May 2001 with a painful left upper arm after falling off a crate. A fractured left humerus was diagnosed, the arm was placed in a sling, and the patient was sent home. Upon reviewing the radiograph the following day, the attending radiologist noticed abnormal lung findings and called the patient, who reported a 1- to 2-month history of dyspnea on exertion. Several months earlier he was found to have an ejection fraction of 30% by echocardiogram, as well as severe chronic pulmonary obstructive disease. A partial gastrectomy had been performed many years previously, and a bypass operation had been done in one leg. He had no known allergies. The only medicine he was taking was a “water pill,” although several medications had been prescribed after a recent hospital discharge. During his last admission, he had tested negative for HIV. He smoked one pack of cigarettes per day for 45 years, smoked crack at least once per week, and drank 4 to 6 beers 4 to 5 times a week. (BUMC Proceedings 2002;15:430-432)