Successful lung transplantation for talcosis secondary to intravenous abuse of oral drug

Dekel Shlomi¹, David Shitrit¹, Daniele Bendayan¹, Gidon Sahar², Yitshak Shechtman³, Mordechai R Kramer¹

¹Pulmonary Institute, Departments of ²Cardiothoracic Surgery and ³Pathology, Rabin Medical Center, Beilinson Campus, Petah Tiqwa, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Abstract: Talcosis due to intravenous injection of oral drugs can cause severe pulmonary disease with progressive dyspnea even when drug use is discontinued. We describe a 54-yearold woman with severe emphysema who underwent left lung transplantation. The patient had a remote history of intravenous injection of crushed methylphenidate (Ritalin) tablets. Chest computed tomography showed severe emphysematous changes, more prominent in the lower lobes. Microscopic examination of the extracted lung demonstrated multinucleated giant cells with birefringent crystals, compatible with talcosis. At follow-up, daily symptoms were completely alleviated and lung function was good. We recommend that lung transplantation be considered as a viable option in the treatment of talcosis.

Keywords: methylphenidate (Ritalin), emphysema