An uncommon hazard: Pulmonary talcosis as a result of recurrent aspiration of baby powder

A previously healthy 52-year old woman presented to the hospital with a 6-month history of progressive dyspnea. Associated symptoms included a persistent dry cough that started 2 months prior admission and an unintentional weight loss of 20 pounds over the course of her illness. On lung examination revealed fine bilateral end-inspiratory crackles in both lower and upper lobes. Radiographic studies showed evidence of interstitial lung disease. The patient underwent bronchoscopy were transbronchial biopsies were taken and showed fibrosis of bronchial walls and lung parenchyma with prominent non-necrotizing granulomata that contained abundant polarizing crystalline material. Once the pathologic findings were known, the patient was re-interviewed. She reported that for the last 20-years, she used baby talcum powder regularly at least twice a day, usually after bathing for personal hygiene. In addition, she habitually applied it to her bed sheets nightly. She was started on prednisone at a dose of 0.5 mg/kg/day, which was gradually tapered and then maintained on a dose of 5 mg daily. Her symptoms rapidly improved over weeks to the point whereshe no longer required home oxygen therapy.