CTICasesExcipient Lung Disease (Crushed Opiates and Feculent Material) with Munchausen Syndrome
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Imaging findings
CT images revealed multiple, larger, and randomly distributed nodules scattered throughout the lungs. PET imaging demonstrated that these nodules were highly hypermetabolic. The main pulmonary artery showed slight enlargement, though right heart enlargement was not pronounced. A transbronchial biopsy found foreign material and multinucleated giant cells.
Key takeaways
Excipient lung disease can present with widespread, large, hypermetabolic pulmonary nodules, particularly in patients with a history of intravenous drug use and recurrent line infections involving diverse gut bacteria and fungi. The injection of unusual foreign materials, such as feces, significantly complicates the clinical picture. The presence of such self-inflicted conditions may indicate Munchausen syndrome, where close monitoring (e.g., 24-hour sitter) can resolve recurrent symptoms like bacteremia and fever.
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