Philippe Camus, M.D.

Dijon, France

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Talc (inhaled, sniffed, i.v., intrapleural)

Inhaled, injected or intrapleural, cosmetic, drug excipient-related or therapeutic talc can cause severe ILD, obliterative airway or vascular disase (a condition named Excipient Lung Disease), or a subacute or chronic pleural reaction/scarring. Fundoscopy may evidence characteristic talc retinopathy in longterm users (PMID 24394831). Examination of lung pathology samples under polarized light is essential (PMID 2361397)

Frequency - Incidence

Incidence of respiratory adverse event(s) due to the specific drug as assessed by number of reported/published cases in the literature. Red digits in stars indicate: 0 = Very rare, questionable signal · 1 = < 10 cases · 2 = 10-50 cases · 3 = 50–100 cases · 4 = 100-200 cases · 5 = >200 cases

Evidence level/grade

Evidence level for respiratory adverse event(s) due to the specific drug as estimated using Hill’s (1965), Naranjo’s (1981), and Bégaud’s (1985) criteria applied to published cases. Blue digits in stars indicate: 0 = Questionable · 1 = Low · 2 = Moderate · 3 = Robust · 4 = Definite · 5 = Unquestionable, pathognomonic

I - Interstitial/parenchymal lung disease

I.e

Organizing pneumonia pattern (an area or areas of consolidation on imaging)
I.u

Pneumoconiosis (silicosis, talcosis...)

II - Pulmonary edema - Acute lung injury - ARDS

II.e

ARDS - Acute lung injury
II.h

Hypoxemia, low oxygen saturation (may occur in isolation)

IV - Airway involvement

IV.x

Obliterative bronchiolitis (a pattern consistent with) (see also IVn, XVx)
IV.z

Foreign body aspiration bronchiolitis
IV.ai

Bronchial stenosis/stricture

VI - Pleural and/or pericardial involvement

VI.c

Pleural thickening - Fibrothorax
VI.s

Pleural mass or masses

VII - Pulmonary vasculopathy

VII.b

Pulmonary arterial hypertension
VII.g

Foreign body pulmonary vasculopathy (Excipient lung disease)

VIII - Mediastinal involvement

VIII.f

An enlarged or dense thymus
VIII.n

Mediastinal talcoma

X - Systemic/Distant conditions, syndromes and reactions

X.f

Anaphylaxis-Anaphylactoid reaction (can be fatal)

XI - Miscellaneous

XI.b

Chest pain (acute or subacute), lone or prominent
XI.r

Chest pressure/discomfort

XVI - Imaging

XVI.w

Imaging: Lung nodule or nodules
XVI.ag

Imaging: A pattern similar to pneumoconiotic progressive massive fibrosis (PMF)
XVI.bj

Imaging: Avid pleural uptake on PET-scan

XVII - Distinctive patterns - 'Eye-catchers'

XVII.i

Eye-catcher: Tracer-avid pleural area or areas on PET-CT

XVIII - Cytological, biochemical features of/in BAL, pleural fluid or FNA

XVIII.k

BAL: Talc crystals in macrophages or lying free in BALF

XIX - Pathology

XIX.f

Path: ILD with a granulomatous component (see also Im)
XIX.ab

Path: Foreign body deposits/granulomatous reaction
XIX.ac

Path: Pneumoconiosis (silicosis, talcosis, talcoma)
XIX.an

Path: Foreign body embolism, microangiopathy, vasculopathy
XIX.dd

Path: Birefringent particles in lung tissue and/or cells