Excipient lung disease with transient severe pulmonary hypertension in a healthcare professional injecting crushed oxycodone tablets

Excipient lung disease (ELD) is a rare cause of pulmonary hypertension that occurs due to the intravenous injection of crushed tablets. We present the case of a healthcare professional in her late 30s who presented with a fever in the setting of a Stenotrophomonas maltophilia bacteraemia. During her hospital admission, she established a pattern of transient hypoxia and hypotension, with resolution without targeted management or clear cause identified. She developed progressive pulmonary centrilobular micronodularity on computed tomography and severe pre-capillary pulmonary hypertension. Lung biopsy revealed pulmonary arteriolar deposition of microcrystalline cellulose with an associated giant cell reaction leading to the diagnosis of ELD secondary to injection of crushed oxycodone tablets. In the setting of abstinence from intravenous drug use, the patient made a full recovery. ELD is rare and requires a high index of suspicion to diagnose. Treatment is largely supportive and should include removal of excipient exposure and addiction medicine services.