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Interstitial pulmonary fibrosis and progressive massive fibrosis related to smoking methamphetamine using talc as filler.

Baylor-PA; Sobenes-J; Vallyathan-V
Am J Respir Crit Care Med 2010 May; 181(Meeting Abstracts):A3999
Introduction: Progressive massive fibrosis (PMF) is a radiological term that refers to lesions larger than 1 cm in size that are often bilateral and asymmetric, have well defined margins, and are usually located in the posterior aspect of the upper lobes. They represent a pulmonary complication of occupational inhalation of (but not limited to) coal, silica or talc. PMF has been caused by occupational inhalation of talc (1-2,) as well as intravenous administration of talc-adulterated narcotics (3). We describe interstitial pulmonary fibrosis accompanied by PMF related to recreational inhalation of methamphetamine. Case report: A 49 year-old African American man was evaluated at the Department of Veterans Affairs Central California Health Care system for shortness of breath in December 2002. He gave a 15-20 year history of almost daily smoking methamphetamine before coming to the clinic. He denied IV drug abuse; there were no cutaneous changes of IV drug abuse. Physical exam was unremarkable except for hypertension. Chest roentgenography and computerized tomography revealed diffuse interstitial fibrosis accompanied by more intense consolidation in the posterior aspect of both upper lobes. Needle biopsy of the right upper lung lobe mass lesion showed multinucleated giant cells with non-necrotizing granulomas, stains for acid-fast bacilli and fungi were negative. Polarized light microscopy of the upper lobe biopsy material revealed highly birefringent inorganic particles consistent with talc and other silicates. Because the etiology of the pulmonary mass like lesions was obscure, examination of the tissue sections by scanning electron microscopy combined with back-scattered electron imaging and energy dispersive x-ray spectrometric analysis was carried out to identify the elemental make up of particle inclusions in the lung lesion. These analyses showed that numerous particles in the right upper lobe mass were composed of magnesium-silicate (talc) with iron and aluminum-silicate (clay minerals) with potassium and iron; aluminum silicates were more predominantly present than the magnesium-silicate with iron. Discussion. Nonasbestiform talc has been shown to result in varying degrees of pulmonary fibrosis. Methamphetamine is commonly mixed with drugs known as "fillers"; these include talc, cellulose and corn starch. The most plausible cause of the interstitial pulmonary fibrosis associated with the PMF reported here is recreational inhalation of methamphetamine with talc as a "filler". Interstitial pulmonary fibrosis and PMF from chronic recreational inhalation of methamphetamine that has been adulterated with talc has not previously been described.
Airborne-particles; Biological-effects; Biological-monitoring; Biopsy; Drug-abuse; Drugs; Dust-exposure; Dust-measurement; Dust-particles; Exposure-assessment; Exposure-levels; Exposure-methods; Inhalation-studies; Lung; Lung-disorders; Lung-fibrosis; Lung-irritants; Microscopic-analysis; Occupational-diseases; Occupational-exposure; Occupational-hazards; Occupational-health; Occupational-respiratory-disease; Particle-aerodynamics; Particle-counters; Particulate-dust; Particulates; Pulmonary-clearance; Pulmonary-congestion; Pulmonary-disorders; Pulmonary-system; Pulmonary-system-disorders; Respirable-dust; Respiratory-hypersensitivity; Respiratory-infections; Respiratory-irritants; Respiratory-system-disorders; Statistical-analysis; Toxic-effects; X-ray-analysis
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American Journal of Respiratory and Critical Care Medicine