Bronchiolitis in a patient with talcosis.

Despite environmental monitoring, widely used occupational standards, and an increasing knowledge of the causative agents of occupational respiratory diseases, new cases of pneumoconiosis still occur. Pulmonary disorders caused by inhalation of talc (magnesium silicate, Mg,SI401, (OH)2) have been described among workers in various industries. " Interstitial inflammation with lymphocytic infiltration , granulomas, and birefringent material are typical findings in lung tissue of patients with talcosis.' 2 Bronchiolar changes, however, have never been described and this paper is the first report of bronchiolitis in patients with talcosis. Case report A 43 year old talc mine loader who operated a tractor was admitted to a local chest hospital with dyspnoea, cough, and phlegm. He had worked as a talc loader since 1960. The patient used paper masks only occasionally to prevent dust inhalation. Min-eralogical examination had established that talc from the talc mine occurs in plate and granular forms but not in fibrous form. Personal dust samples were collected inside the tractor during talc loading in 1976 and 1986. The total dust concentration was 86 mg/m3 in 1976 after which time dust filters were installed into the artificial ventilation system of the tractors. In 1986 the total dust concentration was 3-5 mg/m'. The patient had smoked 20 cigarettes a day for 21 years. Contact dermatitis due to nickel was found in patch tests in 1976. He had no history of allergic rhinoconjunctivitis, atopic dermatitis, or other significant diseases. phlegm for eight months. Cough and phlegm occurred both in the mornings and during the work shift. He had dyspnoea only when heavy dust was present and a few hours after exposure to talc dust. The symptoms diminished during weekends. He was admitted to Paivarinne chest hospital where tests of lung function showed a restrictive ventilatory defect and decreased diffusing capacity (table). No abnormalities were detected on chest x ray film or in routine laboratory tests. No bronchial hyper-reactivity was found by metacholine bronchodilator (salbutamol). Precipitating antibodies to Aspergillus fumigatus, A umbrosus, Thermoactinomyces vulgaris, and Faenia rectivirgula (Micropolyspora faeni) could not be detected in the patient's serum by immunodiffusion tests. Cultures for M tuberculosis, other bacteria, and fungi were negative and eosinophilic granulocytes were not present in sputum. All tests to measure antibodies to viral agents were negative. Antinuclear antibodies or rheumatoid factor were not found. Skin prick tests with nine inhalant allergens were negative for immediate weal and flare reactions. The patient was …