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Talcosis

Pneumoconiosis Talc

Talcosis is a rare pulmonary disease caused by intake of high levels of talcum powder. It is closely related to other silicosis variants and can lead to pulmonary hypertension with cor pulmonale in fatal manifestations. It develops as a consequence of talcum inhalation or because of drug use. Radiographic scans help in diagnosis. Corticosteroid and oxygen therapies may ease symptoms and provide long-term recovery perspectives.


Presentation

Talcosis is a rare pulmonary ailment caused by the inhalation or the intravenous administration of talcum. Inhalation accumulates talcum powder in the lungs leading to either acute or chronic disease. It was first described in the late 19th century [1] as an occupational disease in miners and millers. Workers in the ceramic, paper, plastics, rubber, paint, construction and cosmetic industries are at an increased risk of developing this disorder [2]. Talcum is also often deployed as an adulterant for marijuana and heroin, so patients with a history of drug abuse may also develop talcosis [3].

The symptoms range from very mild, often missed signs of a cough, dyspnoea, chest tightness, wheezing, hypoxemia, in rare cases scleroderma or rheumatoid arthritis and in most severe cases pulmonary hypertension with cor pulmonale. The presentation can be easily confounded with typical chain smoker symptoms and can progress after exposure. The patients have an increased risk of developing tuberculosis and carcinomas, if talcum has been ingested in association with asbestos and/or pure silica [4] [5]. Talcum is hydrated magnesium silicate. Its inhalation typically occurs in conjunction with pure silica dust. Chemically neat talcum is usually ingested in patients with drug abuse history. In acute manifestations, the condition additionally shows severe alveolitis and alveolar fillings [3] [6].

The inhalation process leads to inorganic deposits in the lungs, which cause a granulomatous inflammatory reaction and the formation of granulomas encasing the ingested talcum and macrophages. These granulomas can develop in intra- and perivascular areas as well as in the interstitium. Macrophages will harvest deposited talcum and migrate to proximal lymph nodes or bronchioles or remain in the granuloma until the become apoptotic. Released part of the compound will then be phagocytosed by new macrophages. The migration of these cells is more often observed during lung infection or edema episodes [6].

Intravenous Drugs
  • Abstract The authors describe the computed tomographic (CT) appearances in three patients with pulmonary talcosis resulting from chronic intravenous drug abuse.[ncbi.nlm.nih.gov]
  • Occupational exposure to talc dust and intravenous drug abuse are well-recognised aetiological factors with only a few cases related to cosmetic talc exposure being reported to date.[ncbi.nlm.nih.gov]
  • Here we report a case of pulmonary intravascular talcosis mimicking miliary tuberculosis in a young male intravenous drug addict from North-Eastern Estonia, known as a hotspot for tuberculosis and drug misuse.[ncbi.nlm.nih.gov]
  • Talcosis is a type of pneumoconiosis and can be prevalent in intravenous drug users. It is one of the four recognised types talc induced lung disease .[radiopaedia.org]
  • Additionally, the injection of talc has been associated with pulmonary talcosis in intravenous drug users. Smoking methaqualone pills can lead to emphysema and other chronic lung disorders, most notably talcosis .[diki.pl]
Intravenous Administration
  • Abstract Pulmonary foreign body granulomatosis following intravenous administration of medications meant for oral use among drug addicts has been occasionally reported.[ncbi.nlm.nih.gov]
  • 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.[ncbi.nlm.nih.gov]
  • Talcosis is a rare pulmonary ailment caused by the inhalation or the intravenous administration of talcum. Inhalation accumulates talcum powder in the lungs leading to either acute or chronic disease.[symptoma.com]
Hypoxemia
  • The symptoms range from very mild, often missed signs of a cough, dyspnoea, chest tightness, wheezing, hypoxemia, in rare cases scleroderma or rheumatoid arthritis and in most severe cases pulmonary hypertension with cor pulmonale.[symptoma.com]
Cough
  • Abstract Pulmonary talcosis is a rare but debilitating variant of pneumoconiosis often presenting with isolated non-specific symptoms of progressive exertional dyspnoea or cough.[ncbi.nlm.nih.gov]
  • 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.[ncbi.nlm.nih.gov]
  • The symptoms range from very mild, often missed signs of a cough, dyspnoea, chest tightness, wheezing, hypoxemia, in rare cases scleroderma or rheumatoid arthritis and in most severe cases pulmonary hypertension with cor pulmonale.[symptoma.com]
  • We report a case of talc pneumoconiosis/talcosis in a 51yr old male who presented with breathlessness and dry cough for the past 5 yrs and progressively worsening for the past 5 days.[ijmrhs.com]
  • Symptoms can include cough, difficulty breathing, and may progress to more severe symptoms. Exposure can either be related to inhalation or through IV drug use.[patientslikeme.com]
Pulmonary Disorder
  • Pulmonary talcosis , less specifically referred to as talcosis , is a pulmonary disorder caused by talc. Pulmonary talcosis , less specifically referred to as talcosis , is a pulmonary disorder caused by talc .[wikinow.co]
  • Also found in: Encyclopedia , Wikipedia . talcosis [ tal-ko sis ] tal·co·sis ( tal-kō'sis ), A pulmonary disorder related to silicosis, occurring in workers exposed to talc mixed with silicates; characterized by restrictive or obstructive disorders of[medical-dictionary.thefreedictionary.com]
  • Pulmonary talcosis is a pulmonary disorder caused by talc. It has been related to silicosis resulting from inhalation of talc and silicates. It is also tied to heroin use where talc might be used as an adulterant to increase weight and street value.[en.wikipedia.org]
  • Pulmonary talcosis , less specifically referred to as talcosis , is a pulmonary disorder caused by talc . It has been related to silicosis resulting from inhalation of talc and silicates.[ipfs.io]
  • Pulmonary talcosis , less specifically referred to as talcosis , is a pulmonary disorder caused by talc.[diki.pl]
Dyspnea
  • Abstract Talcosis due to intravenous injection of oral drugs can cause severe pulmonary disease with progressive dyspnea even when drug use is discontinued.[ncbi.nlm.nih.gov]
  • 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.[ncbi.nlm.nih.gov]
  • In a review of several case reports of symptomatic pulmonary talcosis , patients typically presented with initial dyspnea to progressive exertional dyspnea, fatigue, and cough with or without systemic symptoms such as fever, chills, or night sweats [6[medical-dictionary.thefreedictionary.com]
  • A 58-year-old-man with a history of intravenous drug abuse, chronic hepatitis C, and anxiety presented to our emergency department twice in 4 weeks with progressive dyspnea and night sweats.[mdedge.com]
  • 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 .[link.springer.com]
Aspiration
  • Abstract Unusual extracellular birefringent laminated ovoid structures are seen in bronchial brushing, aspiration, and washing specimens in a 28-year-old woman who had histologic evidence of pulmonary talcosis.[ncbi.nlm.nih.gov]
  • Three of them (talcosilicosis, talcoasbestosis, and pure talcosis) are associated with aspiration and differ in the composition of the inhaled substance.[ncbi.nlm.nih.gov]
Dry Cough
  • We report a case of talc pneumoconiosis/talcosis in a 51yr old male who presented with breathlessness and dry cough for the past 5 yrs and progressively worsening for the past 5 days.[ijmrhs.com]
  • As it impacts a person's respiratory system, it's common for people with Talcosis to develop a persistent dry cough and unintentional weight loss. On top of this, the normal range of symptoms common to dust diseases also applies.[gerardmaloufpartners.com.au]
Abdominal Pain
  • Eighteen years later, the patient was hospitalized for abdominal pain that remained refractory to antacids; he subsequently underwent a right hemicolectomy.[ncbi.nlm.nih.gov]

Workup

The diagnosis requires a detailed analysis of the patient's occupational exposure. If the history reveals (past) professional activities with increased risk for this disorder or exaggerated private use of talcum powder can be confirmed, the next step is a pulmonary function test. A smoking habit may cause further worsening of symptoms [7].

Radiographic and computed tomography (CT) examinations are gold standard methods to confirm the diagnosis. CT scans have recently become more popular since they are more suitable to reveal parenchymal abnormalities than radiographs. Typical CT findings are small centrilobular nodules associated with heterogeneous conglomerate masses, sometimes including lower lobe emphysema. Interstitial thickening may also be observed [8].

Acute manifestations are always progressive and result in respiratory failure. The chronic state can be treated with a combination of oxygen and corticosteroid therapies [9] [10].

Pulmonary Infiltrate
  • Pulmonary talcosis must be considered in the differential diagnosis of pulmonary infiltrates of HIV-positive drug addicts.[ncbi.nlm.nih.gov]
  • Ben-Haim SA, Ben-Ami H, Edoute Y, Goldstien N, Barzilai D (1988) Talcosis presenting as pulmonary infiltrates in an HIV-positive heroin addict. Chest 94:656–658 CrossRef PubMed Google Scholar 19.[link.springer.com]
Pulmonary Calcification
  • Calcification No progressive massive fibrosis Emphysema if present admixed with ground-glass opacities or consolidation Centrilobular nodules larger and mulberry shape and tend to cluster Predominantly disease of upper lung zones Silicosis Occupational[radiologykey.com]

Treatment

  • The condition was caused by intravenous administration of crushed tablets of diphenhydramine, but miliary tuberculosis was misdiagnosed on patient's demographical, clinical and radiological grounds and a decision to start treatment with four first-line[ncbi.nlm.nih.gov]
  • We recommend that lung transplantation be considered as a viable option in the treatment of talcosis.[ncbi.nlm.nih.gov]
  • Emphasizes the treatment of the fetus and the mother as separate patients with distinct needs. Delivers contributions from many leaders in the fields of obstetric anesthesia and maternal-fetal medicine in the U.S., Canada, and Great Britain.[books.google.com]
  • In initial stages sanatorium treatment is shown.[en.medicalmed.de]

Etiology

  • Youmans [ 5 ] reported a fatal cardiac arrest of undetermined etiology in a 23-year-old youth immediately after a pleural poudrage.[ispub.com]

Pathophysiology

  • Talcosis Pathophysiology: Talc is hydrated magnesium silicate. Related to silicosis in view of silicate composition. Talc may cause disease in association with other minerals, as there is often contamination with silica, or asbestos.[medicalchemy-respiratory.blogspot.com]

Prevention

  • As these substances get trapped in the respiratory system, they prevent it from operating effectively. What causes Talcosis? Talc is an important component of medicinal tablets.[gerardmaloufpartners.com.au]
  • The disease is characterized by chronic and often progressive hardening or scarring (fibrosis) of the lungs and can manifest itself as a restrictive lung disease (preventing the lungs from fully expanding and filling with air when breathing in), obstructive[jerebeasleyreport.com]
  • "Our research shows that comprehensive surveillance programs, including exposure assessment and structured medical evaluation, are the keystones of prevention and contribute to a safe and healthy workplace," Rooijackers said.[medpagetoday.com]
  • “Our research shows that comprehensive surveillance programmes including exposure assessment and structured medical evaluation are the keystone of prevention and contribute to a safe and healthy workplace, thus underlining the recommendations in the ERS[europeanlung.org]
  • Intravascular pulmonary talcosis is seen predominantly in those who chronically inject intravenous drugs intended for oral use. 1,2 Many oral medications contain talc as a filler and lubricant to prevent the tablet from sticking to equipment during the[mdedge.com]

References

Article

  1. Thorel C. Talc lung: a contribution to the pathological anatomy of pneumoconiosis. Beitr Pathol Anat Allgem Pathol. 1896; 20:85-101.
  2. Kuschner WG, Stark P. Occupational lung disease, Part 2. Discovering the cause of diffuse parenchymal lung disease. Postgrad Med. 2003; 113(4):81-88.
  3. Scheel AH, Krause D, Haars H, Schmitz I, Junker K. Talcum induced pneumoconiosis following inhalation of adulterated marijuana: a case report. Diagn Pathol. 2012; 7:26.
  4. Onder M, Onder S. Evaluation of occupational exposures to respirable dust in underground coal mines. Ind Health. 2009; 47(1):43-49.
  5. Ogawa S, Imai H, Ikeda M. Mortality due to silico-tuberculosis and lung cancer among 200 whetstone cutters. Ind Health. 2003; 41(3):231-235.
  6. Karkhanis VS, Joshi JM. Pneumoconioses. The Indian Journal of Chest Diseases & Allied Sciences. 2013; 55:25-34.
  7. Beckett WS. Occupational respiratory diseases. N Engl J Med. 2000;342:406-412.
  8. Marchiori E, Lourenço S, Gasparetto TD, Zanetti G, Mano CM, Nobre LF. Pulmonary talcosis: imaging findings. Lung. 2010; 188:165-171.
  9. Yacoub WG, Salzman G. Steroids Use in Treatment of Inhalational Talcosis. Chest. 2007; 132(4):700.
  10. Goodman GB, Kaplan PD, Stachura I, Castranova V, Pailes WH, Lapp NL. Acute silicosis responding to corticosteroid therapy. Chest. 1992; 101: 366–370.

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Last updated: 2017-08-09 18:13