Talcum induced pneumoconiosis following inhalation of adulterated marijuana, a case report

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Abstract

Background

Talcosis, a granulomatous inflammation of the lungs caused by inhalation of talcum dust, is a rare form of pneumoconiosis. Besides inhalative occupational exposure, intravenous abuse of adulterated drugs is a major cause for this condition. Minerals such as talcum (magnesium silicate) and sand (predominant silicon dioxide) are used to increase both volume and weight of illicit substances. In intravenous heroin-abuse, talcosis is a well-known complication. Here we describe a case of talcosis caused by inhalative abuse of adulterated marijuana.

Clinical history

A 29-year old man presented with persistent fever, dyspnea and cervical emphysema. He admitted consumption of 'cut' marijuana for several years, preferentially by water pipe smoking.

Morphologic findings

Lung-biopsies showed chronic interstitial lung disease, anthracotic pigments and birefringent material. Energy dispersive x-ray spectroscopy revealed silicon-containing particles (1-2 μm) and fine aluminum particles (< 1 μm), magnesium and several other elements forming a spectrum compatible with the stated water pipe smoking of talcum-adulterated marijuana.

Conclusions

The exacerbated chronic interstitial lung disease in a 29-year old patient could be attributed to his prolonged abuse of talcum-adulterated marjuana by histopathology and x-ray spectroscopy. Since cannabis consumption is widely spread among young adults, it seems to be justified to raise attention to this form of interstitial pulmonary disease.

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Most cited references 8

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Granulomatous lung disease: an approach to the differential diagnosis.

Anthony A Gal, Sanjay Mukhopadhyay (2010)

Granulomas are among the most commonly encountered abnormalities in pulmonary pathology and often pose a diagnostic challenge. Although most pathologists are aware of the need to exclude an infection in this setting, there is less familiarity with the specific histologic features that aid in the differential diagnosis. To review the differential diagnosis, suggest a practical diagnostic approach, and emphasize major diagnostically useful histologic features. This review is aimed at surgical pathologists who encounter granulomas in lung specimens. Pertinent recent and classic peer-reviewed literature retrieved from PubMed (US National Library of Medicine) and primary material from the institutions of both authors. Most granulomas in the lung are caused by mycobacterial or fungal infection. The diagnosis requires familiarity with the tissue reaction as well as with the morphologic features of the organisms, including appropriate interpretation of special stains. The major noninfectious causes of granulomatous lung disease are sarcoidosis, Wegener granulomatosis, hypersensitivity pneumonitis, hot tub lung, aspiration pneumonia, and talc granulomatosis.

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The medical complications of drug addiction and the medical assessment of the intravenous drug user: 25 years later.

J Sapira, C Cherubin (1993)

To review changes in the medical complications of drug abuse that have occurred since the authors reviewed them 25 years ago. Manual search of the internal medicine and subspecialty literature of the past three decades that was selected by the authors. Selected studies were of three types--baseline studies for the period ending in 1968, studies after 1968 that emphasized changes from baseline, and studies after 1968 that emphasized change (or the absence of change) and the manner in which clinicians conceptualized problems. We extracted data that showed changes in the diseases, the appearance of new diseases, or the disappearance of formerly common diseases. The diseases complicating drug abuse are now more widely disseminated than they were in the last 25 years. Some former "diseases of addiction" such as tetanus and malaria are now rare. Diseases (such as human immunodeficiency virus infection) not known to exist or rare 25 years ago now occur frequently. The drugs of abuse have also changed; for example, cocaine is now much more common. Treating the acute medical problems (mostly infectious diseases) in poor, undereducated, and often noncompliant intravenous drug users is far more complex than previously described. Although some features have remained constant, the emergence of human immunodeficiency virus infection and changes in patterns of drug use have radically altered patient management.

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Pulmonary talcosis: imaging findings.

Gláucia Zanetti, Edson Marchiori, Luiz Felipe Nobre … (2010)

Talc is a mineral widely used in the ceramic, paper, plastics, rubber, paint, and cosmetic industries. Four distinct forms of pulmonary disease caused by talc have been defined. Three of them (talcosilicosis, talcoasbestosis, and pure talcosis) are associated with aspiration and differ in the composition of the inhaled substance. The fourth form, a result of intravenous administration of talc, is seen in drug users who inject medications intended for oral use. The disease most commonly affects men, with a mean age in the fourth decade of life. Presentation of patients with talc granulomatosis can range from asymptomatic to fulminant disease. Symptomatic patients typically present with nonspecific complaints, including progressive exertional dyspnea, and cough. Late complications include chronic respiratory failure, emphysema, pulmonary arterial hypertension, and cor pulmonale. History of occupational exposure or of drug addiction is the major clue to the diagnosis. The high-resolution computed tomography (HRCT) finding of small centrilobular nodules associated with heterogeneous conglomerate masses containing high-density amorphous areas, with or without panlobular emphysema in the lower lobes, is highly suggestive of pulmonary talcosis. The characteristic histopathologic feature in talc pneumoconiosis is the striking appearance of birefringent, needle-shaped particles of talc seen within the giant cells and in the areas of pulmonary fibrosis with the use of polarized light. In conclusion, computed tomography can play an important role in the diagnosis of pulmonary talcosis, since suggestive patterns may be observed. The presence of these patterns in drug abusers or in patients with an occupational history of exposure to talc is highly suggestive of pulmonary talcosis.

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Author and article information

Journal

Journal ID (nlm-ta): Diagn Pathol

Journal ID (iso-abbrev): Diagn Pathol

Title: Diagnostic Pathology

Publisher: BioMed Central

ISSN (Electronic): 1746-1596

Publication date Collection: 2012

Publication date (Electronic): 15 March 2012

Volume: 7

Page: 26

Affiliations

[1 ]Institute of Pathology, Klinikum Bremen-Mitte, St.-Jürgen-Str. 1, 28177 Bremen, Germany

[2 ]Department of Pneumology and Respiratory Medicine, Klinikum Bremen-Ost, Züricher Str. 40, 28325 Bremen, Germany

[3 ]Institute of Pathology, Ruhr-Universität Bochum, Berufsgenossenschaftlichen Universitätsklinik Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany

[4 ]Department of Molecular Oncology, University Medicine Göttingen, Justus-von-Liebig-Weg 4, 37077 Göttingen, Germany

Article

Publisher ID: 1746-1596-7-26

DOI: 10.1186/1746-1596-7-26

PMC ID: 3348083

PubMed ID: 22420484

SO-VID: 546eb534-bee4-4a16-be43-acb76b4202cd

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Talcum induced pneumoconiosis following inhalation of adulterated marijuana, a case report

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Abstract

Background

Clinical history

Morphologic findings

Conclusions

Virtual slides

Related collections

Karger: Ophthalmology

Most cited references 8

Granulomatous lung disease: an approach to the differential diagnosis.

The medical complications of drug addiction and the medical assessment of the intravenous drug user: 25 years later.

Pulmonary talcosis: imaging findings.

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