A wide range of both infectious and noninfectious causes may produce dyspnea and cough. The febrile IVDU with dyspnea and/or cough should be assumed to have tuberculosis until an alternative diagnosis is found, particularly those with known or suspected HIV. 20 Other common causes of dyspnea include both community-acquired and opportunistic pneumonia and septic pulmonary emboli from right-sided endocarditis. Opportunistic infections, such as P. carinii pneumonia, reflect the prevalence of HIV disease in this patient group.

Noninfectious causes of dyspnea include pneumothorax, hemothorax, and toxic reactions to injected substances.21 Pneumo- and hemothorax are seen most commonly with the practice of "pocket shooting." As drug users run out of easily accessible veins, they will inject into veins in the supraclavicular fossa to access the subclavian, jugular, or brachiocephalic vein. When talc is injected, it can cause a syndrome of progressive respiratory distress and diffuse interstitial infiltrates known as talc lung 2 Hypersensitivity reactions, associated with both heroin and cocaine injection, present with cough and wheezing and usually respond to inhaled beta-agonist therapy. Noncardiogenic pulmonary edema also has been described in association with heroin and cocaine use. Patients complain of dyspnea, and chest radiographs reveal diffuse alveolar infiltrates. Needles breaking off in the peripheral circulation can embolize into the lungs. 23 Pericarditis also has been reported secondary to central migration of a needle fragment.

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