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The aim of this report is to describe the anatomic-pathologic findings from necropsies of 5 drug addicts with titanium pigment in several organs after chronic intravenous injection of crushed propoxyphene hydrochloride tablets. Samples from liver, spleen, lungs, lymph nodes, and bone marrow were obtained, and after being grossly studied, they were submitted to evaluation using common light and polarized microscopy. In all 5 cases, a pigment with characteristics of titanium dioxide was found within tissue samples of the organs studied. Our findings suggest that research concerning titanium pigment within body tissues should be enhanced, considering the potential contribution of this morphologic data to forensic pathology. Titanium dioxide TiO 2 is a mineral that is also called rutile Latin rutilus : reddish or pink. It is usually found with a little iron and is usually a reddish-brown color, and it constitutes a major source of titanium. Some drug addicts intravenously inject crushed tablets of propoxyphene hydrochloride, which contain talc basic silicate of magnesium , calcium, and titanium as excipients, and particles of these minerals can be found within tissue samples from their internal organs 1,2. Although talc granulomatosis has been described in association with intravenous injection of propoxyphene hydrochloride 2 , we performed a literature review using the key words: titanium, drug addiction, propoxyphene hydrochloride, talc, and necropsy, and we found a single report of titanium pigment deposited in tissues of drug addicts 1. The exclusive aim of this report is to describe the anatomic-pathologic findings from 5 additional cases of drug addicts with titanium pigment in several organs after chronic intravenous injection of crushed propoxyphene hydrochloride tablets. Five white male adults, mean age 36 years, at least 2 years previously utilizing intravenous injections that contained crushed propoxyphene hydrochloride tablets, were submitted to complete necropsy. In all the cases, titanium deposits were noted within the liver, spleen, lymph nodes, lungs, and bone marrow. Grossly, the deposits were seen as chalky streaks and dots Figs. The granules appeared greenish-tan to black on hematoxylin-eosin staining Figs. This report is in general agreement with the literature reporting titanium pigment in organs of individuals with history of intravenous injection of propoxyphene hydrochloride 1 ; however, we found the mineral deposits to be grossly white, while some authors have reported them as black 1,3. Such difference in color could be, at least in part, explained by the presence of other elements associated with titanium in tissues Moreover, is not entirely clear if the finding of titanium pigment within several organs is always related to intravenous titanium injection for the following reasons: 1 this relationship may be not easily demonstrated in drug addicts; 2 patients with orthopedic prosthesis can show titanium pigment in the nearby soft tissues 7 and in regional draining lymph nodes 3 , in addition to increased titanium concentrations in hairs 8 ; 3 occupational exposition to titanium dust may be associated with pulmonary deposition of white pigment titanium dioxide , without local inflammatory changes 9 ; 4 significant species differences in pulmonary responses to experimentally inhaled titanium dioxide particles have been observed in rodents 10 ; 5 dark granular pigment in macrophages of human gut-associated lymphoid tissue is rich in titanium dioxide 5 ; and 6 titanium and other trace elements may be found in samples from normal and cirrhotic livers 4. As revealed by these facts, it seems that additional research is needed to better resolve this matter. Finally, the identification of titanium pigment in several organs may indicate illicit drug use, which could be useful in medico-legal investigations. Abrir menu Brasil. Abrir menu. Titanium; Drug addiction; Propoxyphene hydrochloride; Talc; Necropsy. Key words: Titanium. Drug addiction. Propoxyphene hydrochloride. Cloridrato de propoxifeno. Histopathology, ; Sinus histiocytosis of pelvic lymph nodes after hip replacement. A histiocytic proliferation induced by cobalt-chromium titanium. Am J Surg Pathol ; 18 : Trace elements in normal and cirrhotic human liver tissue. Iron, copper, zinc, selenium, manganese, titanium and lead measured by X-ray fluorescence spectrometry. Liver ; Characterization of inorganic microparticles in pigment cells of human gut associated lymphoid tissue. Gut ; Pigments of the gastrointestinal tract: a comparison of light microscopic and electron microscopic findings. Ultrastruct Pathol ; Titanium lymph node pigmentation in reconstruction plate system of a mandibular bone defect. Emission spectrophotometric analysis of titanium, aluminium, and vanadium levels in the blood, urine, and hairs of patients with total hip arthroplasties. Ital J Orthop Traumatol ; Massive pulmonary deposition of rutile after titanium dioxide exposure: Light-microscopical and physico-analytical methods in pigment identification. Acta Pathol Microbiol Scand ; Long-term pulmonary responses of three laboratory rodent species to subchronic inhalation of pigmentary titanium dioxide particles. Toxicol Sci ; Publication Dates Publication in this collection 23 Apr Date of issue History Received 09 June Marcus Aurelho de Lima. Figures 6. Google Google Scholar. Titanium pigment in tissues of drug addicts: report of 5 necropsied cases.

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