{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T05:09:52Z","timestamp":1772168992129,"version":"3.50.1"},"update-to":[{"DOI":"10.12688\/f1000research.51927.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,7,7]],"date-time":"2021-07-07T00:00:00Z","timestamp":1625616000000}}],"reference-count":24,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2021,7,7]],"date-time":"2021-07-07T00:00:00Z","timestamp":1625616000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004257","name":"The Western Norway Health Authority","doi-asserted-by":"publisher","award":["912001"],"award-info":[{"award-number":["912001"]}],"id":[{"id":"10.13039\/501100004257","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns3:p>\n                    <ns3:bold>Background<\/ns3:bold>\n                    :\u00a0Intravenous injection of oral opioid substitution drugs (OSD) is widespread among injecting drug users. Several OSDs contain the polymer polyvinylpyrrolidone (PVP) as an excipient. Parenterally administered PVP of high molecular weight may accumulate in tissues and organs. This phenomenon was first described in the 1950s, when PVP was utilised in medication for parenteral use.\u00a0We report\u00a0a\u00a0case of an opioid-addicted patient with extensive PVP\u2013deposition caused by repeated injections of OSDs.\n                  <\/ns3:p>\n                  <ns3:p>\n                    <ns3:bold>Case presentation<\/ns3:bold>\n                    :\u00a0A 30-year-old\u00a0male\u00a0drug addicted patient in opioid substitution therapy (OST) was repeatedly referred to his local hospital in a poor general condition. Work-up revealed severe normocytic anaemia,\u00a0renal insufficiency, pancreas insufficiency and pathological fractures. Biopsies from fractured bones, bone marrow and gastric mucosa showed extensive infiltrates of histiocytes with intracytoplasmic vacuoles. Vacuole content stained slightly bluish in\u00a0hematoxylin\u00a0and eosin stain, red in Congo red stain and black in periodic acid methenamine silver stain. The morphological appearance and staining properties were in accordance with the diagnosis of PVP deposition. The patient had been injecting both buprenorphine tablets and a specific methadone syrup for several years. The methadone syrup contained large amounts of high molecular weight PVP, making it the most likely cause of the deposition. His health quickly\u00a0deteriorated\u00a0and he died, impaired by multi-organ failure and\u00a0cachexia, five years after the first diagnosis of PVP-deposition. The autopsy revealed\u00a0extensive\u00a0PVP-deposition in all\u00a0sampled\u00a0organs and tissues.\n                  <\/ns3:p>\n                  <ns3:p>\n                    <ns3:bold>Conclusions<\/ns3:bold>\n                    : Histological investigation and the correct identification of PVP in the biopsies led to the discovery of a severe adverse effect from\u00a0long-standing\u00a0misuse of a drug.\u00a0The disseminated PVP deposition likely contributed to multi-organ dysfunction and cachexia with a fatal outcome. The deposited PVP likely originated from repeated injections of a certain methadone syrup.\n                  <\/ns3:p>","DOI":"10.12688\/f1000research.51927.2","type":"journal-article","created":{"date-parts":[[2021,7,7]],"date-time":"2021-07-07T12:29:56Z","timestamp":1625660996000},"page":"300","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Case Report: Polyvinylpyrrolidone deposition disease from repeated injection of opioid substitution drugs:\u00a0report of a case with a fatal outcome"],"prefix":"10.12688","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2466-355X","authenticated-orcid":false,"given":"Ida Viken","family":"Stalund","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gro Nygard","family":"Riise","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Friedemann","family":"Leh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0221-7807","authenticated-orcid":false,"given":"Tormod Karlsen","family":"Bj\u00e5nes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lars","family":"Riise","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Einar","family":"Svarstad","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0764-2941","authenticated-orcid":false,"given":"Sabine","family":"Leh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2021,7,7]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"161-165","DOI":"10.5694\/j.1326-5377.2009.tb02729.x","article-title":"Injection of medications used in opioid substitution treatment in Australia after the introduction of a mixed partial agonist-antagonist formulation.","volume":"191","author":"L Degenhardt","year":"2009","journal-title":"Med J Aust."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"89-96","DOI":"10.1016\/j.drugalcdep.2014.12.002","article-title":"Illicit use of opioid substitution drugs: prevalence, user characteristics, and the association with non-fatal overdoses.","volume":"147","author":"A Bretteville-Jensen","year":"2015","journal-title":"Drug Alcohol Depend."},{"key":"ref3","first-page":"487-91","article-title":"Complications relating to intravenous buprenorphine abuse: a single institution case series.","volume":"35","author":"A Yeo","year":"2006","journal-title":"Ann Acad Med Singap."},{"key":"ref4","article-title":"Methadone medicinal products for oral use containing povidone.","year":"2014"},{"key":"ref7","first-page":"3430-6","article-title":"Increased gastrointestinal absorption of large molecules in patients after 5-fluorouracil therapy for metastatic colon carcinoma.","volume":"40","author":"G Siber","year":"1980","journal-title":"Cancer Res."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"921-9","DOI":"10.1056\/NEJM195212112472403","article-title":"Polyvinyl pyrrolidone as a plasma expander: studies on its excretion, distribution and metabolism.","volume":"247","author":"H Ravin","year":"1952","journal-title":"N Engl J Med."},{"key":"ref9","first-page":"539-47","article-title":"Complications following the use of plasma expander, especially polyvinylpyrrolidone.","volume":"45","author":"K Honda","year":"1966","journal-title":"Int Surg."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"295-8","DOI":"10.1111\/j.0954-6820.1978.tb08442.x","article-title":"Storage of polyvinylpyrrolidone (PVP) in tissues following long-term treatment with a PVP-containing vasopressin preparation.","volume":"204","author":"M Christensen","year":"1978","journal-title":"Acta Med Scand."},{"key":"ref11","first-page":"1468-82","article-title":"Polyvinylpyrrolidone (PVP), its diagnostic, therapeutic and technical application and consequences thereof.","volume":"21","author":"W Wessel","year":"1971","journal-title":"Arzneimittelforschung."},{"key":"ref12","first-page":"397-405","article-title":"Polyvinylpyrrolidone-storage disease. 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A polyvinylpyrrolidone (PVP) storage disease simulating signet-ring cell carcinoma.","volume":"8","author":"T Kuo","year":"1984","journal-title":"Am J Surg Pathol."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"286-92","DOI":"10.1097\/01.mp.0000062653.65441.da","article-title":"Embolized crospovidone (poly[N-vinyl-2-pyrrolidone]) in the lungs of intravenous drug users.","volume":"16","author":"S Ganesan","year":"2003","journal-title":"Mod Pathol."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"53-62","DOI":"10.1016\/0379-0738(87)90083-1","article-title":"The nature and the occurrence of birefringent material in different organs in fatal drug addiction.","volume":"34","author":"B Kringsholm","year":"1987","journal-title":"Forensic Sci Int."},{"key":"ref20","doi-asserted-by":"crossref","first-page":"308-14","DOI":"10.1001\/archsurg.1954.01270030037004","article-title":"Physiological and pathological effects of long-term polyvinylpyrrolidone retention.","volume":"69","author":"W Altemeier","year":"1954","journal-title":"AMA Arch Surg."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"33-41","DOI":"10.1016\/s0169-6009(08)80079-7","article-title":"'Mucoid dissolution' of bones and multiple pathologic fractures in a patient with past history of intravenous administration of polyvinylpyrrolidone (PVP). 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To address your comment, we have added the following sentence in the second paragraph of the discussion: \u201cPVPs light blue color in H&amp;E and the typical localization of the deposits differentiates it from the non-water soluble variant of PVP, crospovidone.\u201d and added your suggested reference.","URL":"https:\/\/f1000research.com\/articles\/10-300\/v2#referee-comment-6846","order":2,"name":"referee-comment-6846","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"Ida Viken Stalund was funded by The Western Norway Health Authority [grant number 912001]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":3,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}