CRA47 BREATH TAKEN AWAY: A REVEALING CASE OF SILICOSIS PROGRESSING TO MASSIVE FIBROSIS

Deepa Priya Naidu Subramaniam¹, Zul Amali Bin Che Kamaruddin¹, Lalitha Pereirasamy¹, Irfhan Ali Hyder Ali¹

¹ Respiratory Department, Hospital Pulau Pinang, Pulau Pinang, Malaysia

INTRODUCTION
Silicosis is a preventable yet irreversible occupational lung disease, arises from prolonged inhalation of crystalline silica dust, leading to progressive fibrosis and increased vulnerability to tuberculosis (TB) and chronic obstructive pulmonary disease (COPD). Despite its known risks, delayed diagnosis remains challenging, particularly in cases mimicking malignancy or pulmonary infections. This case highlights a former wireman with persistent respiratory symptoms and progressive lung fibrosis initially misdiagnosed as TB and COPD.

CASE SUMMARY
A 55-year-old former wireman, ex-smoker with 50 pack years, unemployed for five years, presented with chronic cough and worsening dyspnea. Initial imaging showed bilateral perihilar masses, raising suspicion of malignancy. CT-guided biopsy and bronchoscopy were negative for malignancy and TB but empirically treated for PTB with no significant improvement. He was later diagnosed with COPD based on symptoms and spirometry which showed severe obstruction, hence he was placed on triple therapy. Serial CT imaging showed features of silicosis with progressive massive fibrosis (PMF). His occupational history of prolonged silica dust exposure strongly supported a diagnosis of chronic silicosis. Financial and psychosocial constraints further delayed specialized care.

DISCUSSION
Silicosis can mimic TB and malignancy, leading to misdiagnosis and inappropriate treatment. Silicosis with progressive massive fibrosis, as seen in this case, underscores the importance of early recognition. His history of occupational exposure, radiological findings, and progressive respiratory decline align with chronic silicosis complicated by PMF. A high index of suspicion, detailed occupational history, and early imaging are crucial for accurate diagnosis.

CONCLUSION
This case highlights the diagnostic pitfalls of silicosis and the necessity for clinician awareness in occupational lung diseases. Early detection and preventive strategies are essential to reduce disease burden and improve patient outcomes.