Pulmonary Vascular Talc Granulomatosis

Abstract

A 37-year-old physician who had multiple intestinal resections for complications of Crohn's disease developed disseminated malignant melanoma following excision of a primary cutaneous melanoma. He required long-term parenteral nutrition via a subclavian catheter because of the Crohn's disease and a surgically shortened bowel with multiple fistulas. Metastatic melanoma and episodes of partial intestinal obstruction caused recurrent pain, necessitating analgesic medication. The patient was known to self-administer pulverized meperidine hydrochloride (Demerol) tablets in suspension via his indwelling venous catheter over a period of several months prior to his death. At autopsy extensive deposits of metastatic melanoma were found in the gastrointestinal tract, heart, lungs, liver, and lymph nodes. The lungs demonstrated acute pulmonary edema. Microscopy showed widespread intravascular and perivascular foreign-body granulomas involving small pulmonary arterioles. These were composed of multinucleated giant cells and histiocytes with variable fibrosis, incorporating numerous yellowish refractile crystals having an elongated, needlelike, or rhomboidal shape. The