[Talc pulmonary granulomatosis caused by intravenous administration of methylphenidate]

A 57-year-old man was admitted with fever and a dry cough in 1985. He had used methylphenidate intravenously for 3 years. A chest X-ray film on admission showed diffuse micronodular shadows and massive lesions in the lower lung fields bilaterally. Pulmonary granulomatosis was diagnosed histologically, but the etiology remained unclear. In 1993, the patient was readmitted because of symptom exacerbation. The micronodular shadows had extended and the bilateral, massive lesions had enlarged. Transbronchial lung biopsy revealed granulomas with crystallized foreign bodies. Electron microscopy confirmed that the foreign bodies consisted of magnesium and silicon, suggesting talc. Talc granulomatosis caused by intravenous administration of methylphenidate was subsequently diagnosed. The symptoms improved with conservative treatment, and no signs of reexacerbation have appeared.