Excipient lung disease in a patient taking the benzodiazepine derivative etizolam: A case report

Abstract

Excipient Lung Disease is an inflammatory response to the intravenous administration of oral formulations of drugs and their excipients (additives). Previously described offenders include opioids and Ritalin, whose excipients, when crushed and administered intravenously, lead to inflammation and are demonstrated by centrilobular nodules and ground-glass formations on Chest Computed Tomography. In this case report, we demonstrate Chest CT findings of excipient lung disease in a patient using etizolam, a benzodiazepine derivative commonly used as an anxiolytic in Japan. Of note, the patient acquired etizolam for purchase through online retailers without prescription, which is becoming more common occurrence and offers the additional risk of unknown formulations.

Fig. 1

Chest x-ray (A) and lung bases on CT Abdomen and/or Pelvis (B) during emergency department evaluation for trauma and suspected drug use. The chest x-ray revels patchy and nodular opacities at the right lung base. CT demonstrates scattered centrilobular and tree-in-bud ground glass nodules most pronounced in the right lung base. These findings were considered to be related to aspiration in the setting of trauma or pneumonia. A 3 month follow-up CT was recommended.

Fig. 2

Axial (A and B), coronal (C), and sagittal (D) CT chest reconstruction demonstrating extensive gravity dependent ground glass opacities in a primarily centrilobular distribution. Given this appearance, particularly the striking gravity dependence, excipient lung disease was suggested.