A potential cause of asbestos-related granulomatosis due to adulterant contamination in a drug abuser

Our plain-English summary of A potential cause of asbestos-related granulomatosis due to adulterant contamination in a drug abuser, by M.C. Lazzaro, S. Romanò, S. Santoro, et al (Virchows Archiv, 2021).

The study

• Authors: M.C. Lazzaro, S. Romanò, S. Santoro, C. Camuto, A. Carbone, R. Casamassima, S. Abate, F. De-Giorgio
• Journal: Virchows Archiv
• Published: 2021;478(2):361-366
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Drug adulterants containing contaminants have been known to cause lung disease by inhalation or intravenous intake. Talcosis due to intravenous talc injection has been widely described in the literature, whereas the hypothesis of granulomatosis due to asbestos related to adulterated cocaine injection has not yet been explored. Herein, a case of pulmonary granulomatosis due to asbestos fibres related to cocaine injection in a young woman is described. Inorganic material in the lung was first individuated by light microscopy and last was identified using the SEM-EDX method. This case is unique since the occupational and passive inhalation of asbestos was excluded with absolute certainty.

In plain English

This brief report described a single autopsy case: a 39-year-old woman with a long history of injecting cocaine, who was found dead. Cocaine was found in the fluid of her eye and its breakdown product in her blood. The authors suggested cardiorespiratory arrest from an intravenous cocaine overdose. Under the light microscope, her lungs showed scattered foreign body granulomas (clusters of inflammatory cells around foreign material). The authors judged that this material had arrived through the bloodstream rather than by breathing. Electron microscopy with chemical analysis showed needle-shaped fibres containing silicon, oxygen and metals. Two fibres listed in a table were 84.3 and 51.0 micrometres long. The authors identified the fibres as amphibole and said their fibrous shape ruled out talc. No asbestos bodies were found. Based on circumstantial information, the authors excluded workplace or passive inhalation. The authors concluded that the fibres were probably asbestos, carried as a contaminant in talc used to cut the cocaine. In their view, the fibres reached the lungs through the blood vessels and led to pulmonary granulomatosis. This report describes one person, not how often this occurs.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (brief report of a single autopsy, with light microscopy and scanning electron microscopy with chemical analysis, SEM-EDX)
• Who was studied: one 39-year-old woman with a long history of intravenous cocaine abuse, examined at autopsy after she was found dead
• Exposure: intravenous cocaine thought to contain mineral adulterants (talc) contaminated with amphibole fibres. The specific amphibole type is not named.
• Main results:
  • Toxicology found cocaine in the vitreous humour (40 ng/mL) and its metabolite benzoylecgonine in blood (300 ng/mL). A nasal swab was negative.
  • The lungs showed scattered non-necrotising foreign body granulomas. The authors read their shape and location as indicating delivery through the blood vessels rather than inhalation.
  • Under electron microscopy, the fibres were needle-shaped and contained silicon, oxygen and alkali and alkali-earth metals.
  • Two fibres listed in Table 1 measured 84.3 μm long by 2.1 μm wide (aspect ratio 40.1) and 51.0 μm long by 1.3 μm wide (aspect ratio 39.2).
  • The authors identified the fibres as amphibole. They stated that the fibrous shape excluded identification as talc.
  • No asbestos bodies were found (Perls staining negative). The authors took this as confirming the fibres did not come from the air.
  • Occupational or passive inhalation was excluded on the basis of circumstantial information.
• The authors' conclusion: The authors concluded that the fibres' silicate composition was probably attributable to asbestos. In their view, the asbestos was contained as a contaminant in the talc used to adulterate the cocaine, reached the lungs through the vascular system, and led to pulmonary granulomatosis.

Topics

Medical terms in this study, explained in our Lexicon: Talc.

Related studies

• Asbestos contamination of parenteral drugs — W.J. Nicholson, C.J. Maggiore, et al. (1972)
• Pulmonary talc granulomatosis. A complication of drug abuse — G.B. Hopkins, D.G. Taylor (1970)
• Desquamative interstitial pneumonia induced by metal exposure. A case report and literature review — T. Blin, A. De Muret, et al. (2020)
• Role of p53 in the chronic pulmonary immune response to tangled or rod-like multi-walled carbon nanotubes — K.S. Duke, E.A. Thompson, et al. (2018)
• Positive FDG-PET/CT of the pleura twenty years after talc pleurodesis: three cases of benign talcoma — T. Vandemoortele, S. Laroumagne, et al. (2014)
• Pulmonary response of mice to fiberglass: cytokinetic and biochemical studies — I.Y. Adamson, H. Prieditis, et al. (1995)

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