A Rare Case of Talcum Powder Pica Induced Pulmonary Talcosis

Abstract

Finely ground hydrous magnesium silicate, or talcum powder, finds significant utilization in the cosmetic industry for its absorbency. Long-term inhalation exposure to talc is associated with an interstitial lung disease termed talcosis, commonly seen in miners, industry workers, and IV drug users. However, it may unfortunately manifest in the general public secondary to chronic inhalation of talc-containing products. Here, we present a unique case of talcum powder pica induced pulmonary talcosis. 31-year-old female from Jamaica presented for evaluation of mild hemoptysis, subjective fevers, cough, weight loss, and dyspnea of three months duration. Vital signs were unremarkable. Physical examination was notable for bilateral costochondral tenderness. Labs were significant for elevated ESR and CRP. CT chest revealed bilateral apical predominant dense, consolidative airspace opacities with adjacent branching nodular densities and diffuse ground-glass opacification with innumerable miliary nodules. The patient was admitted for tuberculosis rule out. QuantiFERON-TB Gold and four sputum AFB smears and cultures resulted negative. Further questioning revealed history of intentional oral talcum powder ingestion from childhood until age 27. She underwent hemoptysis work-up in Jamaica including lung biopsy for confirmation of suspected sarcoidosis. However, results of pathology confirmed a diagnosis of pulmonary talcosis consistent with her history. Given CT findings, SARS-CoV-2 testing was repeated and resulted positive. However, pharmacologic therapy was not indicated given lack of oxygen requirement. She was discharged with outpatient Pulmonary follow-up. Pulmonary talcosis develops with chronic inhalation or intravenous exposure. Talco-silicosis and talco-asbestosis are seen in miners and industrial workers exposed to high levels of inhaled impure talc. Chronic exposure to cosmetic talc also has the potential to cause talcosis. Lung parenchymal changes are not always acutely evident and may manifest up to four decades after inciting events. Pathologic changes occur in the following three major patterns: diffuse interstitial fibrosis, nodular fibrosis, and foreign body granulomatosis. Pica is defined as the persistent consumption of nonnutritive substances that is not socially acceptable and occurs in the context of mental or medical disorders. As a result of an underlying psychiatric diagnosis, pica behavior was the driving force behind our patient's consumption of talc, resulting in chronic, repetitive inhalation exposure, and ultimately led to the development of pulmonary talcosis. Although our patient reported cessation of consumption four years prior, her exposure over time was significant enough for talcosis to develop. If pica was recognized and intervened upon in childhood, she may have been spared permanent lung injury.