Spontaneous pneumothorax associated with talc pulmonary granulomatosis after cocaine inhalation

We report a case of recurrent spontaneous pneumothorax in a patient with cocaine abuse through inhalation alone. He underwent thoracoscopic apical lung resection with mechanical pleurodesis. Despite the lack of significant radiological features of talc induced pulmonary granulomatosis, pathological findings showed granulomas with foreign materials suggestive of being talc. Electronic microscopy showed that the size of talc particles were <4.0 µm and thus small enough to reach the alveoli.