Silicosis Diagnosed Using Transbronchial Lung Biopsy: The Pivotal Role of Occupational History

TL;DR

A case study shows how occupational history is key to diagnosing silicosis, which can be mistaken for tuberculosis in regions where TB is common.

Contribution

Highlights the importance of occupational history in diagnosing silicosis when radiological features overlap with tuberculosis.

Findings

Silicosis was confirmed via transbronchial lung biopsy after initial TB work-up failed.

Occupational history of 30 years of unprotected mosaic tiling was crucial for diagnosis.

Radiologic overlap between silicosis and TB can lead to diagnostic delays in TB-endemic regions.

Abstract

Pulmonary silicosis, a preventable occupational lung disease caused by chronic inhalation of crystalline silica dust in industries like construction, mining, and stone masonry, remains underdiagnosed in TB‐endemic regions due to overlapping clinical and radiological features. A 63‐year‐old man presented with upper gastrointestinal bleeding, but a silent lung abnormality stole the clinical spotlight. In a TB‐endemic setting, incidental reticulonodular opacities triggered a full tuberculosis work‐up, even in the absence of cough or respiratory symptoms. Yet it was only after a delayed occupational history revealed three decades of unprotected mosaic tiling that silicosis was considered. High‐resolution CT and transbronchial lung biopsy later confirmed the diagnosis, but not before the patient's course was complicated by obstructive uropathy and sepsis. This case highlights the diagnostic pitfalls of radiologic overlap between silicosis and tuberculosis, as well as the crucial role of occupational exposure history in reaching the correct diagnosis.

In TB‐endemic regions, incidental lung findings may be misleading. This case highlights the diagnostic challenge of distinguishing silicosis from tuberculosis and emphasizes that a thorough occupational exposure history, coupled with transbronchial lung biopsy, is essential for accurate diagnosis, especially when radiologic features overlap and respiratory symptoms are absent.

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