Pulmonary granulomatous reaction: talc pneumoconiosis or chronic sarcoidosis?

Our plain-English summary of Pulmonary granulomatous reaction: talc pneumoconiosis or chronic sarcoidosis?, by P. Tukiainen, J. Nickels, E. Taskinen, et al (British Journal of Industrial Medicine, 1984).

The study

• Authors: P. Tukiainen, J. Nickels, E. Taskinen, M. Nyberg
• Journal: British Journal of Industrial Medicine
• Published: 1984;41(1):84-7
• Type of article: Case report
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001653).

Abstract

A chronic pulmonary granulomatous reaction was associated with an almost identical clinical picture in two patients exposed to talc. In both patients lung biopsy showed the deposition of talc particles and a heavy granulomatous reaction. At the time of diagnosis the Kveim test result was negative in both patients, urinary calcium excretion was normal, and there were no extrapulmonary manifestations and no response to steroid treatment. These findings point against sarcoidosis. The serum angiotensin-converting enzyme level, however, was raised in both patients. It was concluded that the patient who was exposed to talc in the rubber industry had a true talc pneumoconiosis. The other patient, who was exposed to cosmetic talcum powder, suffered from chronic sarcoidosis with talc deposition in the lungs, since an enlarged axillar lymph node containing granulomatous inflammation was discovered after two years' follow up. These cases show that it may be extremely difficult to differentiate between chronic sarcoidosis and talc pneumoconiosis even after careful clinical and histological analysis.

In plain English

This case report from Helsinki, Finland, described two women with a chronic granulomatous lung reaction and talc particles in lung tissue. Case 1, aged 58, had applied non-powdering talc to her face for 20 years, then cosmetic talcum powder two to three times a day for 10 years, about two boxes a year. Case 2, aged 55, had packed talc-dusted rubber balls from 1958 to 1968. Biopsies in both showed granulomas containing particles resembling talc. In Case 1, electron probe analysis found magnesium and silicon, characteristic of talc. Some ferruginous bodies were seen in Case 2. Both had negative Kveim tests, normal urinary calcium, raised serum ACE, and no improvement on prednisolone. Two years later, Case 1 had an enlarged armpit lymph node showing granulomatous inflammation. The authors concluded that Case 2 had true talc pneumoconiosis and Case 1 had chronic sarcoidosis with coincidental talc deposition, and that the two conditions may be extremely difficult to tell apart. They noted that, except perhaps for talc-containing giant cells, the biopsy findings did not establish a causal link between talc and disease.

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 of two patients: one exposed to cosmetic talcum powder, and one exposed to industrial talc, described for comparison
• Who was studied: Two women exposed to talc, seen at hospitals in Helsinki, Finland: Case 1 aged 58 (cosmetic talcum powder user, 20-year smoker) and Case 2 aged 55 (former rubber-ball packer, smoked 10 cigarettes a day for 30 years)
• Exposure: Talc. Case 1 used cosmetic talc and talcum powder at home. Case 2 packed rubber balls from 1958 to 1968 and was exposed to talc used as a dusting agent to keep the balls from sticking.
• Main results:
  • Case 1 applied non-powdering talc to her face for 20 years. After that she used talcum powder two to three times a day for a 10-year period, usually in an unventilated room, about two boxes a year in total.
  • Case 1 lung biopsy showed heavy granulomatous inflammation with birefringent particles inside giant cells. Electron probe microanalysis found magnesium and silicon with chlorine, calcium, iron and zinc, which the authors called characteristic of talc.
  • Case 1 serum ACE was normal (38 U/l) in November 1980 and raised (70 U/l) in February 1981. It fell to 26 U/l during steroid treatment and rose again to 77 U/l after treatment stopped.
  • Case 1 showed no improvement in lung function or radiographs when prednisolone treatment was discontinued after nine months.
  • After two years' follow-up, Case 1 had an enlarged axillary (armpit) lymph node, and its biopsy showed granulomatous inflammation.
  • Case 2 needle lung biopsy showed numerous small interstitial granulomas containing particles, most of them double-refractile and resembling talc particles.
  • Some ferruginous bodies were also seen in Case 2's lung biopsy.
  • Neither patient had signs of disease outside the lungs compatible with sarcoidosis. In both, the Kveim test was negative and urinary calcium excretion was normal.
  • Case 2's prednisolone treatment in 1973 was stopped after two months because no objective improvement was seen.
  • In April 1980, Case 2's diffusing capacity was 51% of predicted, and serum ACE was slightly raised at 49 micromol/l (normal 40).
• The authors' conclusion: The authors believed the rubber-industry patient (Case 2) had true talc pneumoconiosis. They believed the cosmetic talcum powder user (Case 1) had chronic sarcoidosis with coincidental talc deposition in the lungs. They concluded that even after careful clinical, laboratory and biopsy examination, it may be extremely difficult to differentiate chronic sarcoidosis from talc pneumoconiosis.
• Limitations the authors state:
  • The authors stated that, except perhaps for the talc-containing giant cells, the findings of dust particles and foreign body granulomas in lung tissue do not establish a causal relationship between talc and the disease.
  • The authors stated that a raised ACE level alone cannot exclude talc pneumoconiosis, and that it may be a nonspecific finding regardless of the cause of the granulomas.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Talc and vermiculite.

Medical terms in this study, explained in our Lexicon: Talc, Pneumoconiosis, Biopsy, Deposition, Inflammation.

Related studies

• Pulmonary talc granulomatosis. A complication of drug abuse — G.B. Hopkins, D.G. Taylor (1970)
• Relative release of interleukin-1 beta and interleukin-1 receptor antagonist by alveolar macrophages. A study in asbestos-induced lung disease, sarcoidosis, and idiopathic pulmonary fibrosis — J.N. Kline, D.A. Schwartz, et al. (1993)
• Chitotriosidase activity in sarcoidosis and some other pulmonary diseases — M. Tercelj, B. Salobir, et al. (2009)
• Mixed pneumoconiosis: silicosis, asbestosis, talcosis, and berylliosis — G.J. Mark, C.B. Monroe, et al. (1979)
• Talc: understanding its manifestations in the chest — D.S. Feigin (1986)
• Morbidity and Mortality in Talc Granuloma: Report of a Fatal Case — A.J. Swingle (1948)

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