scholarly journals THYROID ABSCESS AFTER INJECTION OF HEROIN INTO THE NECK COMPLICATED BY THYROID STORM

2020 ◽  
Vol 6 (4) ◽  
pp. e183-e188
Author(s):  
Christine Mathai ◽  
Anthony Coppola ◽  
Cherie Lisa Vaz
Keyword(s):  
Drug Use ◽  
Reference Range ◽  
Free Thyroxine ◽  
Intravenous Drug ◽  
Thyroid Storm ◽  
Antithyroid Drugs ◽  
Intravenous Drug Use ◽  
Surgical Drainage ◽  
Thyroid Abscess ◽  
The Right

Objective: Our objective is to present a case of thyroid abscess complicated by thyroid storm secondary to intravenous drug use. Cases of thyroid abscess causing thyrotoxicosis are rare. This is the first report of thyroid abscess from intrathyroidal injection of illicit drugs resulting in thyroid storm. Methods: We used biochemical evaluation, computed tomography (CT), and ultrasound to assess the thyroid abscess. Treatment included antithyroid drugs, steroids, antibiotics, and surgical drainage. Results: A 28-year-old female presented with neck pain and fever after injecting heroin into her neck. CT showed bilateral thyroid abscesses measuring 3.0 cm on the left and 2.0 cm on the right. Thyroid-stimulating hormone (TSH) was 0.40 mIU/L (reference range is 0.34 to 5.60 mIU/L). She left against medical advice, then returned with worsening symptoms. CT showed multiloculated, bilateral thyroid abscess measuring 8.6 cm on the left and 5.3 cm on the right. She suffered a cardiac arrest and was resuscitated. Her white blood cell count was 25.9 × 103 cells/mL, TSH <0.01 mIU/L, free thyroxine was 4.25 ng/dL (reference range is 0.89 to 1.76 ng/dL), triiodothyronine was 96 ng/dL (reference range is 70 to 204 ng/dL), and thyroid-stimulating immunoglobulin was <89% (reference range is <140%). She had fever, tachycardia, heart failure, and elevated bilirubin confirming a diagnosis of thyroid storm by Japan Thyroid Association criteria and Burch-Wartofsky score. She was treated with propylthiouracil, hydrocortisone, and antibiotics. Two days later her TSH was <0.005 mIU/L, free thyroxine was 3.06 ng/dL, and triiodothyronine was 62.0 ng/dL. Ultrasound showed enlarged, heterogeneous thyroid with loculated fluid collections. Following surgical abscess drainage, her thyroid function normalized and progressed to hypothyroidism. Conclusion: We conclude that thyroid abscess can be a life-threatening complication of intravenous drug use as it can precipitate thyroid storm. Along with surgical drainage of the abscess, successful management includes antithyroid drugs, antibiotics, and steroids to control thyrotoxicosis, infection, and inflammation.

scholarly journals MON-463 Thyroid Abscess Due to Intravenous Drug Use: A Rare Cause of Thyroid Storm

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Christine Mathai ◽  
Anthony Coppola ◽  
Cherie Vaz
Keyword(s):  
Cardiac Arrest ◽  
Drug Use ◽  
Intravenous Drug ◽  
Thyroid Storm ◽  
Antithyroid Drugs ◽  
Intravenous Drug Use ◽  
Suppurative Thyroiditis ◽  
Thyroid Abscess ◽  
Acute Suppurative Thyroiditis ◽  
The Right

Abstract Objective: Our objective is to discuss the clinical presentation, diagnosis and management of thyroid storm due to thyroid abscess. Methods: We report a case of thyroid abscess due to intravenous drug use (IVDU) resulting in thyroid storm. Results: A 28 year old female with history of IVDU and no known thyroid disease presented with neck pain and fever after injecting heroin into her neck 10 days prior. CT Neck showed an early bilateral thyroid abscess 3.0 cm on the left and 2.0 cm on the right, with heterogeneous enhancement in the rest of the thyroid concerning for thyroiditis. TSH 0.4 m[iU]/L (0.34–5.60 m[iU]/L). She was started on antibiotics but left AMA. She returned 9 days later with worsening neck swelling and pain. CT neck showed a multiloculated, bilateral thyroid abscess 8.6 cm on the left and 5.3 cm on the right. She suffered a cardiac arrest, was intubated, and resuscitated with defibrillation and epinephrine. WBC 25.9 K/mm3, ANC 9.8 K/mm3, TSH &lt;0.01 m[iU]/L (0.34–5.60 m[iU]/L), fT4 4.25 ng/dL (0.89–1.76 ng/dL), T3 96.0 ng/dL (70–204 ng/dL), TSI &lt;89 (&lt;140%). Burch-Wartofsky score was 60. She was treated with propylthiouracil (PTU) and hydrocortisone. She developed transaminitis post-arrest due to shock liver, AST 2881 U/L (15–37 U/L), ALT 981 U/L (16–61 U/L) and PTU was discontinued. Two days later TSH &lt;0.005 m[iU]/L (0.4–4.5 m[iU]/L), fT4 3.06 ng/dL (0.89–1.76 ng/dL), T3 62.0 ng/dL(60.0–181.0 ng/dL). Neck ultrasound showed enlarged, heterogeneous thyroid with numerous loculated fluid collections. Incision and drainage (I&D) drained 100 cc of pus and drains were left in situ. Cultures grew MRSA. Patient was treated with vancomycin, clindamycin, and metronidazole. Following I&D, thyroid function improved to normal and eventual hypothyroidism by postoperative day 8, fT4 0.59 ng/dL, T3 32.1 ng/dL, TSH 1.2 m[iU]/L. She was initiated on levothyroxine 50 mcg daily with follow up testing for possible resolution of thyroiditis-induced hypothyroidism. Discussion: Thyroid abscess causing acute suppurative thyroiditis presenting as thyroid storm is rarely seen1. There are no reported cases of thyroid storm occurring as a complication of IVDU. Acute suppurative thyroiditis has been reported following MSSA bacteremia from a forearm abscess due to IVDU, TSH 0.02U/mL, fT4 3.89ng/dL, fT3 of 5.1pg/mL2. Presentation was consistent with thyrotoxicosis but not thyroid storm2. It is important to consider thyroid abscess as a rare cause of thyroid storm, in patients with risk factors such as IVDU. Management with antithyroid drugs (ATD), steroids, antibiotics, and I&D produced successful outcomes in this patient after cardiac arrest. Conclusion: Thyroid abscess resulting in thyroiditis can be a rare cause of thyroid storm that resolves following I&D. Successful management includes use of antibiotics, steroids, and ATD for thyroid infection, thyroid inflammation and thyroid hormone levels.

scholarly journals Intravascular Talcosis due to Intravenous Drug Use Is an Underrecognized Cause of Pulmonary Hypertension

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Christopher C. Griffith ◽  
Jay S. Raval ◽  
Larry Nichols
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Drug Use ◽  
Intravenous Drug ◽  
Granulomatous Disease ◽  
Intravenous Drug Use ◽  
Left Heart ◽  
Foreign Material ◽  
History Of ◽  
The Right

Intravenous injection of illegal drugs or medications meant for oral administration can cause granulomatous disease of the lung. This intravascular talcosis results in pulmonary fibrosis and pulmonary hypertension. Nine cases of histologically confirmed intravascular talcosis were reviewed with specific attention given to the clinical histories in these patients. Five autopsy cases were included in this series with detailed investigation in the anatomic features associated with intravascular talcosis and pulmonary hypertension. All nine patients showed perivascular and/or intravascular deposition of polarizable foreign material in their lungs. Intravascular talcosis as a result of previous intravenous drug use was not clinically suspected in any patient despite clinically diagnosed pulmonary hypertension in five. All patients showed dilatation of the right and left heart, but none had dilatation of the aortic valve. Congestive heart failure with hepatosplenomegaly was also common. We conclude that intravascular talcosis is an underdiagnosed cause of pulmonary hypertension in patients with known history of intravenous drug use.

Review of HIV Infection and Intravenous Drug Use.

1993 ◽  
Vol 38 (6) ◽  
pp. 655-656
Author(s):  
Terri Gullickson
Keyword(s):  
Drug Use ◽  
Hiv Infection ◽  
Intravenous Drug ◽  
Intravenous Drug Use

scholarly journals 191. oral versus Intravenous Antibiotic Treatment in Skin and Soft Tissue Infections as a Consequence of Intravenous Drug Use: A Retrospective Study to Demonstrate Noninferiority

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S224-S224
Author(s):  
Aryn M Andrzejewski ◽  
J Alex Viehman
Keyword(s):  
Soft Tissue ◽  
Drug Use ◽  
Length Of Stay ◽  
Oral Therapy ◽  
Statistical Difference ◽  
Treatment Completion ◽  
Intravenous Drug ◽  
Soft Tissue Infections ◽  
Intravenous Drug Use ◽  
Oral Group

Abstract Background Skin and soft tissue infections (SSTIs) are among the most prevalent infectious complications of intravenous drug use (IVDU). Given its polymicrobial nature, studies focusing on SSTIs in the general population may not be generalizable this group. We completed a retrospective chart review to better characterize the safety and efficacy of oral versus intravenous (IV) antibiotics for the treatment SSTIs in IVDU. Methods We reviewed patients admitted with bacterial SSTIs and IVDU from January 01, 2012 to December 31, 2019 based on ICD-10 codes. SSTIs complicated by bacteremia, endocarditis, bone or joint involvement on index admission were excluded. Patients who received &lt; 48 hours of IV antibiotics were considered oral therapy, otherwise they were considered IV therapy. Patient comorbidities, incision and drainage (I&D) status, substance use, microbiology and antimicrobial data were reviewed. Results Of 231 eligible patients, 84 received oral therapy. There was no statistical difference in patient characteristics between the two therapy groups. Streptococcus anginosus group were the most common organisms found (33%) followed by Staphylococcus aureus (31%). There was no statistical difference between rates of readmission (p=0.87), recurrent primary site infection (p=1.00), repeat debridement (p=0.08) or occurrence of deep-seated infections within 90 days of treatment completion. No morality was observed. The oral group had shorter length of stay (3 vs. 5 days, p &lt; 0.001) and shorter total duration of antibiotics (10 vs. 13 days, p &lt; 0.001). Overall, 90% of those with abscess underwent I&D, which did not differ between therapy groups. Time to I&D was shorter (0 vs. 1 day, p=0.005) in the oral group. Patients who did not receive and I&D were more likely to be readmitted within 90 days (p=0.025). Conclusion In SSTIs related to IVDU, oral antibiotic therapy was noninferior to IV in terms of mortality, readmission, and deep-seated infection rates within 90 days of treatment completion and had a decreased length of stay and total treatment duration. A delay in I&D led to increased length of stay and lack of I&D increased readmission rate. Therefore, a prompt I&D may allow a safe and effective early transition to oral therapy in SSTIs related to IVDU. Disclosures All Authors: No reported disclosures

Endocarditis and the impact of intravenous drug use: a cohort study

2021 ◽  
pp. 1-7
Author(s):  
Christopher H. D. Lawrence ◽  
James Cheaveau ◽  
Michalis Kavourides ◽  
David Chadwick ◽  
Brendan McCarron
Keyword(s):  
Cohort Study ◽  
Drug Use ◽  
Intravenous Drug ◽  
Intravenous Drug Use ◽  
The Impact

Constitutional Challenges to the Compulsory HIV Testing of Prisoners and the Mandatory Segregation of HIV-Positive Prisoners

1993 ◽  
Vol 73 (3) ◽  
pp. 391-422 ◽  
Author(s):  
KENNETH C. HAAS
Keyword(s):  
Risk Factor ◽  
Drug Use ◽  
Hiv Infection ◽  
Supreme Court ◽  
Hiv Testing ◽  
Intravenous Drug ◽  
Hiv Positive ◽  
Intravenous Drug Use ◽  
Homosexual Activity ◽  
Mandatory Testing

Intravenous drug use is both a common aspect of the pre-imprisonment lifestyles of many American prisoners and a leading risk factor for contracting HIV—the virus that causes AIDS. Moreover, incarcerated inmates frequently engage in behavior that can spread the disease, particularly homosexual activity and intravenous drug use. Correctional officials face increasing pressure to protect inmates and staff from HIV infection, and some have responded by implementing policies requiring all inmates to undergo HIV testing and by housing HIV-positive inmates in separate units. Screening and segregation policies, however, have been challenged on constitutional grounds by HIV-positive prisoners. This article examines the leading constitutional developments in this emerging area of law and finds that most courts so far have been inclined to reject constitutional challenges to mandatory testing and segregation policies. There are enough unsettled issues, however, to warrant expanded appellate review and eventual U.S. Supreme Court resolution of the key constitutional questions.

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