Pulmonary Granulomatous Vasculitis Induced by Insoluble Particulates: A Case Report

The authors report a case of a 39-year-old woman who sustained an injury to her left knee requiring arthroscopic surgical medial menisectomy and ganglionic block for reflex sympathetic dystrophy syndrome. Approximately 1 year after injury, the patient presented with an elevated white blood cell coun...

Full description

Saved in:
Bibliographic Details
Published in:Ultrastructural pathology 2003, Vol.27 (6), p.439-449
Main Authors: Hammar, Samuel P., Williams, M. Glenn, Dodson, Ronald F.
Format: Article
Language:English
Subjects:
Adult
Analytical Transmission Electron Microscopy
Cellulose - adverse effects
Cellulose - ultrastructure
Corn Starch
Excipients - adverse effects
Fatal Outcome
Granuloma, Foreign-Body - etiology
Granuloma, Foreign-Body - pathology
Granuloma, Respiratory Tract - etiology
Granuloma, Respiratory Tract - pathology
Humans
Lung - pathology
Lung - ultrastructure
Male
Microcrystalline Cellulose
Microscopy, Electron
Pulmonary Artery - pathology
Pulmonary Artery - ultrastructure
Pulmonary Granulomatous Vasculitis
Talc
Vasculitis - etiology
Vasculitis - pathology
X-Ray Diffraction
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:The authors report a case of a 39-year-old woman who sustained an injury to her left knee requiring arthroscopic surgical medial menisectomy and ganglionic block for reflex sympathetic dystrophy syndrome. Approximately 1 year after injury, the patient presented with an elevated white blood cell count and fever and was diagnosed to have a psoas muscle abscess, which was treated with antibiotics. She was also taking 4 different oral medications that contained microcrystalline cellulose as a filter. Approximately 1 month after being diagnosed with the psoas muscle abscess, the patient developed shortness of breath, marked weakness, diaphoresis, and intermittent emesis. She became hypotensive and tachyneic and expired. Postmortem examination showed granulomatous vasculitis with extensive occlusions of pulmonary arteries by birefringent crystalline material identified to be cellulose histochemically and by analytical electron microscopy evaluation. This case report describes the ultrastructural and chemical features of various medicinal tablet fillers and compares them to pure samples. This report also demonstrates the usefulness of analytical electron microscopy in accurately identifying birefringent material in lung tissue.
ISSN:0191-3123
1521-0758
DOI:10.1080/01913120390209893