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

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.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.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.The virtual slide(s) for this article can be found here: http://www.diagnomx.eu/vs/krause/html/start.html webcite.Pneumoconioses are restrictive pulmonary diseases caused by chronic inhalation of mineral dust. In many industrialised countries, improvements in occupational health lead to a general decrease of pneumoconiosis over the last 5 decades. Contrary to this trend, the incidence of asbestosis strongly increased until a few years ago rendering it the currently most frequently recorded pneumoconiosis [1]. While talc (hydrated magnesium silicate) is commonly used in various industrial processes, its clinical relevance (Talcosis, ICD-10 J23.0) is fairly low. In addition to chronic inhalation, intravenous drug abuse is a major source of talc-related lung diseases: As talc is used as filling material in tablets, intravenous abuse of drugs intended for oral application causes deposition of the mineral in various organs, notably the lungs [2]. Illicit substances such as heroin are often adulterated to increase volume and weight for which talc is frequently used [3].Talc deposition in the lungs typ