INTRAVENOUS ADMINISTRATION OF CRUSHED METHADONE AND LUNG DISEASE

Sa？etak A 40-year-old patient with fever, chills and pain in the left side of the chest presented to the Emergency Room (ER), Sveti Duh University Hospital. He had been on dual antibiotic therapy for the last 12 days. He was an otherwise treated opiate addict, now on methadone therapy. History data and physical examination were without particular features, vital indicators were normal, and soon after antipyretic and analgesic therapy the patient reported improvement and suggested discharge from ER. However, upon arrival of the ？ ndings, in particular radiological heart and lung examination, additional diagnostic workup was performed. Radiograph of the heart and lungs revealed diffusely decreased ventilation of pulmonary parenchyma bilaterally (reticular nodose interstitium), pronounced vasculature, and intense shadow along the lateral thoracic wall to the right in the basal parts of the upper lobe. Also, due to the radiological ？ ndings described, the subsequently mentioned dyspnea and acknowledgment of intravenous administration of crushed methadone and high d-dimer values, multi-slice computed tomography pulmonary angiography was performed, which indicated embolus in the left main branch of the pulmonary artery and in the lobar branch to the lower lobe, right along with peripheral multiple lung infarctions. At the end of ER treatment, it was concluded that the patient had submassive pulmonary embolism, bilateral pneumonia, changes in pulmonary interstitium, and multiple pulmonary infarctions. As a result, the patient was hospitalized in the Intensive Care Unit, treated with unfractionated heparin, intravenous antibiotics, antifungals, vitamin B12 and other symptomatic therapy. After treatment, laboratory and radiological ？ ndings and the subjective condition of the patient improved, and he was discharged for home treatment with continued anticoagulation therapy