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Roy Temes MD MBA, Joseph Lahorra MD, Inderjit Gill MD, Joseph Tomashefski Jr. MD, Thomas Rice MD
26 year old with progressing interstitial lung disease over 1.5 years Reformed IV drug user, HIV negative
Robotic wedge biopsy, discharged following day Pathology: Talc induced pulmonary granulomas (TIPG) Cultures (including AFB) negative
Cause: Injected tablet adulterants and fillers (talc, cellulose, fibers, other) Result: Loss of pulmonary vasculature, pulmonary hypertension, RVH Treatment (1): Medical: Steroids (inhaled budesonide), vasodilators (hydralazine) Treatment (2): Surgical: Lung transplantation Outcome: Pulmonary insufficiency and/or death
Include TIPG in differential diagnosis of interstitial disease in appropriate clinical setting Findings pathognomonic for drug abuse
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