PMID- 29387512
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200929
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 9
IP  - 11
DP  - 2017 Nov 27
TI  - Mycobacteremia from Crushed Hydromorphone Tablet Injection.
PG  - e1883
LID - 10.7759/cureus.1883 [doi]
LID - e1883
AB  - Mycobacterium abscessus is a fast growing, non-tubercular mycobacterium (NTM) 
      found in water. NTM bacteremia is usually seen in immunocompromised patients who 
      have intravascular catheters. Mycobacterium abscessus bacteremia is often caused 
      by exposure to contaminated water supply in hemodialysis units. A 28-year-old 
      female with poorly controlled diabetes mellitus, end stage renal disease (on 
      hemodialysis via Ash catheter), and recurrent deep vein thrombosis presented to 
      the hospital with proximal right leg deep vein thrombosis. On day nine of 
      admission, the patient spiked a fever. Blood cultures revealed Mycobacterium 
      abscessus bacteremia. The patient was observed to be crushing oral hydromorphone 
      and injecting it into her ash catheter using needles retrieved from the sharps 
      disposal container in her room. Although the Michigan Automated Prescription 
      System (MAPS) report for narcotic abuse was unremarkable, a thorough review of 
      her electronic medical chart revealed multiple hospitalizations with drug seeking 
      behavior. This is the first reported case of crushed oral opioid injection 
      resulting in mycobacteremia. Injecting crushed opioids has become more prevalent. 
      Many opioid abusers resort to injecting them in order to achieve the psychotropic 
      effects quicker. A heightened awareness about nontraditional modes of 
      prescription drug abuse and surveillance by prescribers is necessary. This case 
      raises an ethical question: should such patients be prescribed narcotics in the 
      future, as the outcome of injecting oral medications can be fatal.
FAU - Banno, Joseph M
AU  - Banno JM
AD  - Internal Medicine, St. Joseph Mercy Oakland.
FAU - Shield, Katherine
AU  - Shield K
AD  - St. Joseph Mercy Oakland.
FAU - Patel, Krunal
AU  - Patel K
AD  - Internal Medicine, St. Joseph Mercy Oakland.
FAU - Sule, Anupam A
AU  - Sule AA
AD  - Internal Medicine, St. Joseph Mercy Oakland.
LA  - eng
PT  - Case Reports
DEP - 20171127
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC5786344
OTO - NOTNLM
OT  - addiction
OT  - dialysis contamination
OT  - hydromorphone
OT  - mycobacteremia
OT  - mycobacterium abscessus
OT  - mycobacterium chelonae
OT  - narcotic injection
OT  - opioid abuse
COIS- The authors have declared that no competing interests exist.
EDAT- 2018/02/02 06:00
MHDA- 2018/02/02 06:01
PMCR- 2017/11/27
CRDT- 2018/02/02 06:00
PHST- 2018/02/02 06:00 [entrez]
PHST- 2018/02/02 06:00 [pubmed]
PHST- 2018/02/02 06:01 [medline]
PHST- 2017/11/27 00:00 [pmc-release]
AID - 10.7759/cureus.1883 [doi]
PST - epublish
SO  - Cureus. 2017 Nov 27;9(11):e1883. doi: 10.7759/cureus.1883.