ABSTRACT
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.
Subject(s)
Adalimumab/adverse effects , Arthritis, Psoriatic/drug therapy , Lung Diseases, Interstitial , Lung , Adalimumab/administration & dosage , Aged , Anti-Inflammatory Agents/administration & dosage , Anti-Inflammatory Agents/adverse effects , Arthritis, Psoriatic/diagnosis , Arthritis, Psoriatic/physiopathology , Diagnosis, Differential , Dyspnea/diagnosis , Dyspnea/etiology , Humans , Image-Guided Biopsy/methods , Lung/diagnostic imaging , Lung/pathology , Lung Diseases, Interstitial/chemically induced , Lung Diseases, Interstitial/diagnosis , Lung Diseases, Interstitial/physiopathology , Male , Patient Care Management/methods , Radiography, Thoracic/methods , Thoracoscopy/methods , Tomography, X-Ray Computed/methods , Tumor Necrosis Factor-alpha/antagonists & inhibitorsSubject(s)
Hemophilia A/complications , Hemorrhage/etiology , Mediastinal Diseases/etiology , Aged , Female , HumansSubject(s)
Airway Obstruction/drug therapy , Carcinoma, Non-Small-Cell Lung/surgery , Granuloma, Foreign-Body/drug therapy , Granuloma, Foreign-Body/etiology , Lung Neoplasms/surgery , Pneumonectomy/adverse effects , Steroids/therapeutic use , Airway Obstruction/diagnosis , Airway Obstruction/etiology , Airway Obstruction/surgery , Bronchoscopy , Drug Administration Schedule , Dyspnea/etiology , Dyspnea/prevention & control , Granuloma, Foreign-Body/diagnosis , Granuloma, Foreign-Body/surgery , Humans , Male , Middle Aged , Mitomycin/therapeutic use , Reoperation , Secondary Prevention , StentsABSTRACT
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.
