Pulmonary "mainline" granulomatosis: talcosis secondary to intravenous heroin abuse with characteristic x-ray findings of asbestosis.

A 50-year-old man, a "mainline" heroin abuser for 25 years, with a five-year history of x-ray findings compatible with asbestosis is presented. Multiple open biopsies failed to prove a diagnosis of asbestosis. The microscopic analyses of tissues revealed the presence of granulomatosis, secondary to talc from chronic intravenous heroin abuse. The need for open lung biopsy in establishing a diagnosis is emphasized, as x-ray findings can be and often are misleading. A tissue diagnosis is necessary, particularly in cases in which drug abuse is suspected.