Unusual intestinal talcosis

Our plain-English summary of Unusual intestinal talcosis, by P.A. Anani, C. Ribaux, D. Gardiol (The American Journal of Surgical Pathology, 1987).

The study

• Authors: P.A. Anani, C. Ribaux, D. Gardiol
• Journal: The American Journal of Surgical Pathology
• Published: 1987;11(11):890-4
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 002589).

Abstract

A case of intestinal talcosis in a 46-year-old man is reported. At the age of 27, the patient was treated for pulmonary tuberculosis with tablets containing talc (183 g talc per 2,670 g total drug intake) over a period of 28 months. Eighteen years later, the patient was hospitalized for abdominal pain that remained refractory to antacids; he subsequently underwent a right hemicolectomy. Light-microscopic examination revealed a prominent fibrosis of the intestinal wall in which birefringent particles were demonstrated by polarized light. Using energy-dispersive spectroscopy, an analysis of these particles showed that they were predominantly composed of silicon and magnesium as well as small amounts of phosphorus, sulphur, calcium, and iron--the spectrum typically associated with talc. We believe that the source of this talc is the tablets ingested by the patient during prior antituberculosis therapy.

In plain English

This was a case report by pathologists in Lausanne, Switzerland. It concerned talc, a tablet filler, not asbestos. The patient, a 46-year-old male sound engineer, was treated in 1967, at age 27, for pulmonary tuberculosis with streptomycin injections and oral isoniazide, tiocarlidum and pyridoxine. The total oral drug intake was 2,670 g, containing about 183 g of talc, over 670 consecutive days. In 1985 and 1986 the patient had abdominal pain and underwent a right hemicolectomy. The inner bowel layers showed no lesions. The serosa showed prominent fibrosis, which in places replaced the muscle layer. Fine birefringent crystals lay in the fibrotic areas. Spectroscopy showed mainly silicon and magnesium, a pattern the authors described as characteristic of talc. Surgical gloves from regional hospitals contained starch rather than talc. The authors concluded that the talc came by the oral route. They suggested that the talc crystals caused the fibrosis, but did not propose cause and effect between the massive oral drug ingestion and the fibrosis. They could not explain why the same therapy did not produce the same result in other patients.

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 (single patient)
• Who was studied: One 46-year-old male sound engineer, treated for pulmonary tuberculosis in 1967 at age 27, who had abdominal pain from December 1985 and a right hemicolectomy in 1986. The case was reported by pathologists in Lausanne, Switzerland.
• Exposure: Oral ingestion of talc contained in antituberculosis tablets (tiocarlidum, isoniazide, pyridoxine). Streptomycin was also given, by intramuscular injection. The total oral drug intake was 2,670 g, containing approximately 183 g of talc, over 670 consecutive days (28 months). No asbestos exposure is reported.
• Main results:
  • The serosa of the removed bowel showed prominent fibrosis.
  • In some areas the fibrosis completely replaced the external and internal layers of the muscularis propria.
  • Fine crystals showing double refraction under polarized light and resembling talc were dispersed within the fibrotic areas.
  • Some of the birefringent particles were contained in giant cells.
  • Energy-dispersive spectroscopy showed that the particles consisted predominantly of silicon and magnesium, with small quantities of phosphorus, sulphur, calcium and iron. The authors described this as characteristic of talc.
  • The authors suggested that the cause of the fibrosis of the intestinal wall was the birefringent crystals within it, which they identified by spectroscopy as talc.
  • Surgical gloves examined from different hospitals in the region contained starch rather than talc.
• The authors' conclusion: The authors concluded that the talc was introduced orally rather than by surgery. They suggested a relationship between the talc deposits in the intestinal wall and the fibrosis. They stated that they could not propose cause and effect between the massive oral drug ingestion and the intestinal fibrosis.
• Limitations the authors state:
  • The authors could not explain why the same therapy did not produce the same result in other patients.

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, Fibrosis, energy dispersive X-ray spectroscopy (EDS).

Related studies

• An investigation of the penetration of ingested asbestos into the normal and abnormal intestinal mucosa of the rat — M.E. Meek, P. Grasso (1983)
• Tissue response to intraperitoneal asbestos with preliminary report of acute toxicity of heart-treated asbestos in mice — J. Jagatic, M.E. Rubnitz, et al. (1967)
• Particle size for differentiation between inhalation and injection pulmonary talcosis — J.L. Abraham, C. Brambilla (1980)
• Commercial talc and talcosis — B. Weiss, E.A. Boettner (1967)
• Pulmonary ventilatory function in talcosis of lung — M. Kleinfeld, J. Messite, et al. (1964)
• Mixed pneumoconiosis: silicosis, asbestosis, talcosis, and berylliosis — G.J. Mark, C.B. Monroe, et al. (1979)

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