A 53-year-old woman with chronic pain and progressive dyspnea and cough

A 51-Year-Old Woman With Progressive Dyspnea and Diffuse Bilateral Pulmonary Nodules

CASE PRESENTATION

A 51-year-old woman was referred to our hospital with progressive dyspnea on exertion for 2 months after COVID-19 vaccination (ChAdOx1-S [recombinant] vaccine). She did not have a cough, fever, hemoptysis, weight loss, or night sweats. She had no history of arthritis, rash, photosensitivity, or other signs of autoimmune disease. Chest radiograph revealed diffuse ground-glass opacities and bilateral pulmonary nodules. She denied any history of smoking, contact with individuals infected with TB, relevant hobbies, or exposure to domestic animals. She had no relevant medical history, was previously healthy, and worked as a chef.

A 52-Year-Old Woman With an Abdominal Mass, Bilateral Pulmonary Nodules, and Mediastinal and Hilar Lymphadenopathy

CASE PRESENTATION

A 52-year-old, nonsmoking, African-American woman with a history of obesity, hypertension, and rheumatoid arthritis was referred for workup of multiple bilateral pulmonary nodules. The pulmonary nodules were discovered incidentally while undergoing a CT scan for an abdominal mass that was radiographically diagnosed as a uterine leiomyoma. She was asymptomatic from a pulmonary standpoint without unintentional weight loss, fevers, or night sweats. Her mother and sister had a history of lung cancer. She was diagnosed with rheumatoid arthritis 5 years earlier that was controlled with adalimumab for approximately 3 years when she stopped being seen by her rheumatologist and discontinued adalimumab. During evaluation for the abdominal mass, she re-established care with a rheumatologist and was started on 40 mg prednisone daily with plans to restart adalimumab once the workup for the abdominal mass and pulmonary nodules was completed. She had undergone bariatric surgery with cholecystectomy approximately 5 years earlier, after which she experienced intentional postsurgical weight loss.

Cosmetic Talc-Related Pulmonary Granulomatosis

Inhalation of cosmetic talc can lead to pulmonary foreign-body granulomatosis, though fewer than 10 cases of inhaled cosmetic talc–related pulmonary granulomatosis have been reported in adults. We report the case of a 64-year-old man with diffuse, bilateral pulmonary nodules and ground glass opacities associated with chronic inhalation of cosmetic talc. Transbronchial biopsy showed peribronchiolar foreign-body granulomas. After cessation of talc exposure, the patient demonstrated clinical and radiographic improvement without the use of corticosteroids. This case demonstrates that a conservative approach with cessation of exposure alone, without the use of corticosteroids, can be an effective therapy in cosmetic talc–related pulmonary granulomatosis.