Delayed Silicotuberculosis Diagnosis in a Young Worker: The Importance of Dust Control and Occupational Surveillance

Silicosis is an irreversible occupational lung disease caused by inhaled crystalline silica and is a known risk factor for tuberculosis. We report a 26-year-old male construction worker with more than 10 years of unprotected silica dust exposure who presented with worsening dyspnea, chronic productive cough, and weakness. He had been diagnosed with pulmonary tuberculosis by GeneXpert and was receiving continuation-phase antituberculosis treatment. Chest imaging showed bilateral fibroinfiltrative changes, fibroconsolidation, bronchial dilatation, pleural thickening, and calcified nodules in the right upper lobe, suggesting silicotuberculosis. Bronchoscopy was deferred due to high anesthetic risk, and open lung biopsy with wedge resection was performed. Histopathology showed chronic nonspecific inflammation, dust-laden macrophages, multinucleated giant cells, and fibrosis, without alveolar proteinosis or classic silicotic nodules. Given his more than 10 years of unprotected occupational exposure to silica-containing dust, confirmed pulmonary tuberculosis, and overlapping radiological and pathological abnormalities, the overall presentation was interpreted as silicotuberculosis with an accelerated clinical course. The patient received oxygen therapy, continued antituberculosis treatment, antibiotics, bronchodilator nebulization, mucolytic therapy, and chest physiotherapy. His symptoms improved, but he remained oxygen-dependent during mobilization at discharge. He was subsequently readmitted in May 2024 with worsening respiratory symptoms and died during hospitalization. This case emphasizes the importance of occupational history and further evaluation for silicosis in young tuberculosis patients with persistent respiratory abnormalities and silica exposure.