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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].

Splenomegaly
  • They were found to have increased lung weights and heart weight and dilatation of both right and left heart along with hepatomegaly and splenomegaly.[omicsonline.org]
Cough
  • 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]
Dyspnea
  • Talcosis due to intravenous injection of oral drugs can cause severe pulmonary disease with progressive dyspnea even when drug use is discontinued. We describe a 54-year-old woman with severe emphysema who underwent left lung transplantation.[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]
  • Usually the symptoms are nonspecific and can include dyspnea, cough, fevers, night sweats, weight loss, and spontaneous pneumothorax.[rc.rcjournal.com]
  • 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.[diagnosticpathology.biomedcentral.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]
  • Talcosis Talcosis is a pulmonary disorder characterized by "restrictive or obstructive disorders of breathing or the two in combination" [ Stedman's Medical Dictionary, 2005. p 1436. ] .[en.academic.ru]
  • 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]
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]
  • Case Summary A 34-year-old white male presented with dyspnea, fatigue, and dry cough. A day prior he had reported a syncopal episode, and did not recollect the preceding events.[rc.rcjournal.com]
Chronic Cough
  • Early warning signs of talcosis include shortness of breath, especially during increased activity or physical exertion, and chronic cough.[jerebeasleyreport.com]
Intravenous Drugs
  • 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]
  • However, most intravenous drug abusers are reluctant to give a history of exposure, and most diagnoses are made after lung biopsy.[rc.rcjournal.com]
  • […] with history of intravenous drug abuse [ 4 ].[omicsonline.org]
Intravenous Administration
  • 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]
  • Talc causes 2 broad categories of lung disease: one caused from talc inhalation, and the other from intravenous administration.[rc.rcjournal.com]
  • In comparison to interstitial lung disease due to intravenous administration of talc during drug abuse talc inhalation is a rare form of pneumoconiosis most often caused by occupational exposure.[diagnosticpathology.biomedcentral.com]
Chest Pain
  • He denied any chest pain, palpitations, fever, chills, or night sweats. His medical history was notable for depression, for which he was on trazodone. He also took over the counter analgesics as needed for chronic back pain.[rc.rcjournal.com]

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]
  • A final chest x-ray indicated a slight decrease of the pulmonary infiltration, stepwise reduction of the prednisone and follow-up chest x-rays were recommended.[diagnosticpathology.biomedcentral.com]
  • 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]
Bilateral Pulmonary Infiltrate
  • Figure 1 Chest x-ray showing centrally pronounced bilateral pulmonary infiltrates with ground-glass opacities . Clinical investigations Upon admission blood tests showed high c-reactive protein (145 mg/L) and moderate leukocytosis (15000/μL).[diagnosticpathology.biomedcentral.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]
  • In initial stages sanatorium treatment is shown.[en.medicalmed.de]
  • Treatment for Talcosis None available. Complications of Talcosis of its treatment Lung infections such as pneumonia.[thecorrect.com]

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