Silica associated systemic sclerosis: an occupational health hazard

A middle-aged male working in the sandblasting and stone-cutting industry was brought to the medicine department with skin tightness, dysphagia and discolouration of the skin for the last 1 year. On examination, he had skin thickening over the face and the extremities with restricted mouth opening. His hands were cold and showed peripheral cyanosis. Systemic examination was suggestive of diffuse cutaneous systemic sclerosis, further confirmed by the antinuclear antibody testing. Further, CT of the chest showed mediastinal lymphadenopathy with eggshell calcification and interstitial fibrosis consistent with silicosis and fibrotic non-specific interstitial pneumonitis. The patient was started on pulse monthly cyclophosphamide for six cycles, and steroids were given for 4 weeks and tapered. Tadalafil and amlodipine were given for his pulmonary artery hypertension and Raynaud's phenomenon, respectively. This case also highlights the importance of periodic screening of the workers exposed to silica dust to prevent silicosis.