Pulmonary intravascular talcosis: A case report

• Published in: La revue de medecine interne 2018-08, Vol.39 (8), p.658
• Main Authors: Reverso-Meinietti, J, Vandenbos, F, Risso, K, Coyne, J, Leroy, S, Padovani, B, Burel-Vandenbos, F
• Format: Article
• Language: fre
• Subjects: Adult; Granuloma, Foreign-Body - diagnosis; Granuloma, Foreign-Body - etiology; Humans; Lung - blood supply; Lung - diagnostic imaging; Lung - pathology; Male; Radiography, Thoracic; Talc - adverse effects; Tomography, X-Ray Computed; Vascular Diseases - diagnosis; Vascular Diseases - etiology
• ISSN: 1768-3122
• DOI: 10.1016/j.revmed.2018.03.017

Pulmonary intravascular talcosis is a rare condition occurring in intravenous drug users injecting oral medications. Talc results in a foreign-body granulomatous reaction giving a radiological haematogenic miliary appearance mimicking miliary tuberculosis. Drug users represent a population at risk for both these conditions and their distinction may be challenging. We reported the case of a man, 33 year-old, intravenous drug addict, detected by the health services because he was the partner of a person who died of contagious and multi-resistant tuberculosis. Chest X-ray and CT scan showed a typical miliary appearance. Despite negative microbiology, clinical diagnosis of miliary tuberculosis was retained. Due to the lack of radiological improvement despite appropriate antibiotic treatment, re-evaluation and trans-bronchial biopsy were undertaken. The presence of granulomas centered by birefringent foreign bodies in polarized light led to a diagnosis of pulmonary intravascular talcosis. In the presence of pulmonary miliary in an intravenous drug addict, intravascular talcosis should be suspected.