RESUMEN
A 67-year-old retired air force officer presented with a 6-month history of nonproductive cough, progressive exertional dyspnea, and weight loss. He was unable to walk beyond 100 m compared with his baseline of unlimited walking distance. He denied fever, hemoptysis, myalgia, or chest pain. He had a 30-year history of chronic plaque psoriasis with arthritis, which was managed by his dermatologist with emollients and vitamin D analogues. Joint involvement had previously been controlled with methotrexate, which was discontinued 15 years ago after resolution of his symptoms. He developed a polyarthritis flare a year ago, and adalimumab was initiated with good response.
Asunto(s)
Adalimumab/efectos adversos , Artritis Psoriásica/tratamiento farmacológico , Enfermedades Pulmonares Intersticiales , Pulmón , Adalimumab/administración & dosificación , Anciano , Antiinflamatorios/administración & dosificación , Antiinflamatorios/efectos adversos , Artritis Psoriásica/diagnóstico , Artritis Psoriásica/fisiopatología , Diagnóstico Diferencial , Disnea/diagnóstico , Disnea/etiología , Humanos , Biopsia Guiada por Imagen/métodos , Pulmón/diagnóstico por imagen , Pulmón/patología , Enfermedades Pulmonares Intersticiales/inducido químicamente , Enfermedades Pulmonares Intersticiales/diagnóstico , Enfermedades Pulmonares Intersticiales/fisiopatología , Masculino , Manejo de Atención al Paciente/métodos , Radiografía Torácica/métodos , Toracoscopía/métodos , Tomografía Computarizada por Rayos X/métodos , Factor de Necrosis Tumoral alfa/antagonistas & inhibidoresAsunto(s)
Obstrucción de las Vías Aéreas/tratamiento farmacológico , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Granuloma de Cuerpo Extraño/tratamiento farmacológico , Granuloma de Cuerpo Extraño/etiología , Neoplasias Pulmonares/cirugía , Neumonectomía/efectos adversos , Esteroides/uso terapéutico , Obstrucción de las Vías Aéreas/diagnóstico , Obstrucción de las Vías Aéreas/etiología , Obstrucción de las Vías Aéreas/cirugía , Broncoscopía , Esquema de Medicación , Disnea/etiología , Disnea/prevención & control , Granuloma de Cuerpo Extraño/diagnóstico , Granuloma de Cuerpo Extraño/cirugía , Humanos , Masculino , Persona de Mediana Edad , Mitomicina/uso terapéutico , Reoperación , Prevención Secundaria , StentsRESUMEN
INTRODUCTION: Injecting drug abusers are vulnerable to many infectious complications. We describe a case of tetanus in a Singaporean who regularly abused buprenorphine. CLINICAL PICTURE: A 49-year-old male was hospitalised for progressive generalised spasms associated with dysarthria and opisthotonus. Tetanus was diagnosed clinically. TREATMENT: Supportive management was instituted in the intensive care unit (ICU). Toxicology samples tested positive for buprenorphine. OUTCOME: He recovered rapidly and was transferred out of the ICU after 8 days. Retrospective questioning confirmed parenteral abuse of buprenorphine. CONCLUSION: This case highlights an uncommon and potentially lethal complication of parenteral drug abuse.