Pulmonary Arterial Hypertension Due to Talc Granulomatosis Following Intravenous Use of Oral Medications: A Report of a Rare Case.

Pulmonary talcosis is a rare granulomatous lung disease resulting from the intravenous injection of crushed oral tablets containing insoluble excipients such as talc, microcrystalline cellulose, and crospovidone. These substances embolize within the pulmonary vasculature, provoking granulomatous inflammation that may progress to pulmonary arterial hypertension (PAH). We present a case report of a 25-year-old male who presented with acute-onset shortness of breath, chest pain, dry cough, fatigue, and palpitations. On examination, he was dyspneic and tachypneic and exhibited bilateral basal inspiratory crackles with signs of right heart strain. Imaging revealed elevated right ventricular pressures and computed tomography (CT) findings of centrilobular nodules with sparing of the subpleural regions and fissures, characteristic of talc granulomatosis. A detailed history revealed longstanding intravenous polysubstance abuse over five years, including methamphetamine, tapentadol, and cocaine, likely contributing to his pulmonary pathology. Based on clinical, imaging, and echocardiographic findings, a diagnosis of pulmonary hypertension secondary to talcosis was established. The patient was managed with supplemental oxygen, antiplatelet therapy, and oral sildenafil, resulting in symptomatic improvement, and was strongly advised to cease intravenous drug use. A lung biopsy was planned for histological confirmation. This case report aims to emphasize the importance of recognizing pulmonary talc granulomatosis as a rare but serious complication of intravenous drug use, particularly in patients presenting with unexplained respiratory symptoms, due to its potential to cause irreversible PAH if left untreated.