Skip to main content
Log in

Unusual pulmonary vascular lesions after intravenous injections of microcrystalline cellulose

A complication of pentazocine tablet abuse

  • Original Articles
  • Published:
Virchows Archiv A Aims and scope Submit manuscript

Summary

We present the morphological features of a case of fatal pulmonary granulomatosis from illicit intravenous injections of microcrystalline cellulose derived from pentazocine tablets. Extensive foreign body granulomas were found in the lumena and walls of pulmonary vessels and in the pulmonary interstitium. Previously unreported gaps containing foreign material were found in the walls of medium-sized muscular pulmonary arteries. This peculiar finding is discussed in the light of the possible mechanisms involved in the removal of embolized foreign material.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Allison AC (1970) On the role of macrophages in some pathological processes. In: Van Furth R (ed) Mononuclear phagocytes. Blackwell Scientific Publications, Oxford and Edinburgh, pp 422–444

    Google Scholar 

  • Arnett EN, Battle WE, Russo JV, Roberts WC (1976) Intravenous injections of talc-containing drugs intended for oral use — a cause of pulmonary granulomatosis and pulmonary hypertension. Am J Med 60:711–718

    Google Scholar 

  • Bailey WJ (1979) Nonmedical use of pentazocine. JAMA 242:2392

    Google Scholar 

  • Butch AJ, Yokel RA, Sigell LT, Hanenson IB, Nelson ED (1979) Abuse and pulmonary complications of injecting pentazocine and tripelennamine tablets. Clin Toxicol 14:301–306

    Google Scholar 

  • Butz WC (1969) Pulmonary arteriole foreign body granulomata associated with angiomatoids resulting from intravenous injection of oral medications, e.g. propoxyphene hydrochloride (Darvon). J Forensic Sci 14:317–326

    Google Scholar 

  • Byers JM, Soin JS, Fisher RS, Hutchins GM (1975) Acute pulmonary alveolitis in narcotics abuse. Arch Pathol 99:273–277

    Google Scholar 

  • Cumming G, Henderson R, Horsfield K, Singhai SS (1969) The functional morphology of the pulmonary circulation. In: Fishman AP and Hecht HH (eds) The pulmonary circulation and interstitial space. University of Chicago Press, Chicago and London, pp 327–340

    Google Scholar 

  • Eckmann F, Kubicki SK, Mazaheri P (1975) Zur Frage der Pentazocin-Abhängigkeit. In: Neuhaus GA, Kubicki SK (eds) Pentazocin- ein neuer Weg. Georg Thieme Verlag, Stuttgart, pp 61–64

    Google Scholar 

  • Elliott FM, Reid L (1965) Some new facts about the pulmonary artery and its branching pattern. Clin Radiol 16:193–198

    Google Scholar 

  • Hahn HH, Schweid AI, Beaty HN (1969) Complications of injecting disolved methylphenidate tablets. Arch Intern Med 123:656–659

    Google Scholar 

  • Houck RJ, Bailey GL, Daroca PJ, Brazda F, Johnson FB, Klein RC (1980) Pentazocine abuse — Report of a case with pulmonary arterial cellulose granulomas and pulmonary hypertension. Chest 77:227–230

    Google Scholar 

  • Johnston WH, Waisman J (1971) Pulmonary cornstarch granulomas in a drug user. Arch Pathol 92:196–202

    Google Scholar 

  • Kellermeyer RW, Warren KS (1970) The role of chemical mediators in the inflammatory response induced by foreign bodies: Comparison with the schistosome egg granuloma. J Exp Med 131:21–39

    Google Scholar 

  • King A (1978) Abuse of pentazocine. Br Med J 2:21

    Google Scholar 

  • Kubicki S, Lenhard-Mazaheri P, Beyer KH (1977) Pentazocin — ein Suchtproblem? Münch Med Wochenschr 119:1069–1074

    Google Scholar 

  • Lahmeyer HW, Steingold RG (1980) Medical and psychiatric complications of pentazocine and tripelennamine abuse. J Clin Psychiatry 41:275–278

    Google Scholar 

  • Lewman LV (1972) Fatal pulmonary hypertension from intravenous injection of methylphenidate (Ritalin) tablets. Hum Pathol 3:67–70

    Google Scholar 

  • Liebow AA (1960) Cardiopulmonary disease. In: Gould SE (ed) Pathology of the heart. 2nd edn. Charles C Thomas, Springfield Ill., pp 940–982

    Google Scholar 

  • Poklis A (1978) ‘T's and blues’. JAMA 240:108

    Google Scholar 

  • Poklis A, Whyatt PL (1980) Current trends in the abuse of pentazocine and tripelannamine: The metropolitan St. Louis experience. J Forensic Sci 25:72–78

    Google Scholar 

  • Puro HE, Wolf PL, Skirgaudas J, Vazquez J (1966) Experimental production of human “Blue velvet” and “Red devil” lesions. JAMA 197:1100–1102

    Google Scholar 

  • Robertson B (1967) The normal intrapulmonary arterial pattern in infancy and early childhood, a micro-angiographic and histological study. Acta Pathol Microbiol Scand 71:481–501

    Google Scholar 

  • Showalter CV (1980) T's and blues — abuse of pentazocine and tripelennamine. JAMA 244:1224–1225

    Google Scholar 

  • Showalter CV, Moore L (1978) Abuse of pentazocine and tripelennamine. JAMA 239:1610–1612

    Google Scholar 

  • Siegel H (1972) Human pulmonary pathology associated with narcotic and other addictive drugs. Hum Pathol 3:55–66

    Google Scholar 

  • Spain DM (1950) Patterns of pulmonary fibrosis as related to pulmonary function. Ann Int Med 33:1150–1163

    Google Scholar 

  • Szwed JJ (1970) Pulmonary angiothrombosis caused by “Blue velvet” addiction. Ann Int Med 73:771–774

    Google Scholar 

  • Tomashefski JF, Hirsch CS (1980) The pulmonary vascular lesions of intravenous drug abuse. Hum Pathol 11:133–145

    Google Scholar 

  • Tomashefski JF, Hirsch CS, Jolly PN (1981) Microcrystalline cellulose pulmonary embolism and granulomatosis. Arch Pathol Lab Med 105:89–93

    Google Scholar 

  • Vevaina JR, Civantos F, Viamonte M, Avery WG (1974) Emphysema associated with talcum granulomatosis in a drug addict. South Med J 67:113–116

    Google Scholar 

  • Wagenvoort CA, Wagenvoort N (1977) Pathology of pulmonary hypertension. John Wiley & Sons, New York, pp 75–80

    Google Scholar 

  • Wendt VE, Puro HE, Shapiro J, Mathews W, Wolf PL (1964) Angiothrombotic pulmonary hypertension in addicts. JAMA 188:755–757

    Google Scholar 

  • Zeltner TB, Nussbaumer U (1982) Intravenöse Injektion von aufgelösten Pentazocin-Tabletten (Fortalgesic) — ein neuer Aspekt des Drogenmissbrauchs auch bei uns? Schweiz Med Wochenschr (in press)

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zeltner, T.B., Nussbaumer, U., Rudin, O. et al. Unusual pulmonary vascular lesions after intravenous injections of microcrystalline cellulose. Virchows Arch. A Path. Anat. and Histol. 395, 207–215 (1982). https://doi.org/10.1007/BF00429613

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00429613

Key words

Navigation