Abstract Pulmonary Foreign Body Granulomatosis (PFBG) is a granulomatous lung disease associated with intravenous (IV) injection of crushed oral tablets that contain fillers and bulking agents such as talc, microcrystalline, cellulose, and starch, or rarely, by nasal inhalation of drugs cut with insoluble binding agents. These insoluble particles become lodged in the pulmonary vasculature, eliciting a foreign-body granulomatous reaction that can lead to progressive pulmonary fibrosis and pulmonary hypertension (PHTN). PFGB is diagnosed based on a history of IV injection of crushed tablets, characteristic radiologic findings on high-resolution computed tomography (HRCT), and confirmation of foreign body particles with granulomatous inflammation on lung biopsy. We present a case of 62-year-old woman with a past medical history of IgG deficiency, asthma, and obstructive sleep apnea who initially presented in 2018 for progressive dyspnea and hypoxemic respiratory failure. Her HRCT at that time showed interval development of diffuse micro nodularity. On review it was discovered that she was seeing a homeopathic medicine practitioner and had received ozone therapy and ‘homeopathic IV’ therapy for several weeks. She subsequently underwent a bronchoscopy with transbronchial biopsies which showed “intravascular granulomatous reaction associated with foreign body material consistent with IV drug administration/abuse.” She had no history of IV drug abuse. Given the temporal sequence of her exposure, HRCT imaging and biopsy findings, she was diagnosed with PFBG secondary to IV microcrystalline/talc. She was subsequently diagnosed with PHTN in 2023 by right heart catheterization, and has been on pulmonary vasodilator therapy. She remains on supplemental oxygen. Her Pulmonary function testing (PFT) in 2025 showed normal spirometry and lung volumes and mildly reduced diffusion capacity, stable from 2023. Her HRCT chest in 2024 (fig 1) shows persistent hyperdense micronodules throughout both lungs. Her clinical status is largely unchanged since her presentation 7 years ago. This case report highlights the importance of recognizing PFBG as a rare yet serious complication of intravenous use of crushed medicines, particularly in patients with unexplained respiratory symptoms. Multidisciplinary management and follow up is critical as there are no clearly established treatments for PFBG and these patients can develop further complications. Our patient developed pulmonary hypertension but otherwise has remained relatively stable, likely due to the limited exposure she had and close on-going multidisciplinary follow up. This abstract is funded by: None
Saeed et al. (Fri,) studied this question.