RESUMO
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.
Assuntos
Adalimumab/efeitos adversos , Artrite Psoriásica/tratamento farmacológico , Doenças Pulmonares Intersticiais , Pulmão , Adalimumab/administração & dosagem , Idoso , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/efeitos adversos , Artrite Psoriásica/diagnóstico , Artrite Psoriásica/fisiopatologia , Diagnóstico Diferencial , Dispneia/diagnóstico , Dispneia/etiologia , Humanos , Biópsia Guiada por Imagem/métodos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Doenças Pulmonares Intersticiais/induzido quimicamente , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Pulmonares Intersticiais/fisiopatologia , Masculino , Administração dos Cuidados ao Paciente/métodos , Radiografia Torácica/métodos , Toracoscopia/métodos , Tomografia Computadorizada por Raios X/métodos , Fator de Necrose Tumoral alfa/antagonistas & inibidoresAssuntos
Obstrução das Vias Respiratórias/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Granuloma de Corpo Estranho/tratamento farmacológico , Granuloma de Corpo Estranho/etiologia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/efeitos adversos , Esteroides/uso terapêutico , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/cirurgia , Broncoscopia , Esquema de Medicação , Dispneia/etiologia , Dispneia/prevenção & controle , Granuloma de Corpo Estranho/diagnóstico , Granuloma de Corpo Estranho/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Mitomicina/uso terapêutico , Reoperação , Prevenção Secundária , StentsRESUMO
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.
