Advanced accelerated silicosis misdiagnosed as tuberculosis in a 24-year-old gold miner: A case report

Accelerated silicosis is an aggressive form of pneumoconiosis increasingly observed among young artisanal gold miners. In high tuberculosis (TB) burden settings, its diffuse miliary radiological pattern frequently leads to misdiagnosis as miliary TB, resulting in inappropriate management and delayed supportive care.

We present the case of a 24-year-old male artisanal gold miner in Uganda who presented with a five-month history of progressive dyspnea, cachexia, and fevers. A chest radiograph showed a diffuse miliary pattern, leading to a presumptive diagnosis of smear-negative pulmonary tuberculosis. Despite completing a standard six-month course of anti-tubercular therapy, his condition deteriorated with worsening hypoxia. Subsequent High-Resolution Computed Tomography (HRCT) revealed extensive bilateral upper-lobe Progressive Massive Fibrosis (PMF) with calcifications, a persistent thick-walled cavity, and pulmonary artery enlargement indicative of cor pulmonale.

The diagnosis was revised to advanced accelerated silicosis complicated by pulmonary hypertension. This case highlights the critical diagnostic "mimicry" between silicosis and TB. In occupationally exposed individuals, a lack of microbiological confirmation and non-response to empirical TB treatment should trigger immediate radiological re-evaluation using HRCT to avoid unnecessary drug toxicity and ensure appropriate palliative intervention.