B57-09 The Dust That Does Not Settle: A Case of Silicosis Unveiled in a Granite Cutter

Abstract Introduction Crystalline silica is a mineral found in stone, soil, and sand and is a component of materials like granite and concrete (1). Inhalation of silica particles can cause silicosis, a progressive and irreversible form of interstitial lung disease (ILD) (2). Risk of developing silicosis correlates with duration and intensity of exposure (2). Prolonged, high-intensity exposure to silica is commonly associated with granite cutting and stone-work, among other construction-related activities (3). There is currently no cure or targeted treatment for silicosis. This case highlights a patient who developed silicosis following prolonged workplace exposure to silica. Case A 42-year-old male with rheumatoid arthritis (RA), treated with methotrexate and prednisone, presented with one-month of shortness of breath, acutely worsened over two days. He also reported non-productive cough and fevers. Of note, he moved to the United States from Mexico 15 years prior and has worked as a granite cutter for 10 years. On arrival, vitals showed tachycardia, tachypnea, and hypoxia requiring oxygen. Labs revealed mild lactic acidosis and respiratory PCR positive for non-COVID coronavirus strain and rhinovirus. Chest X-ray showed diffuse bilateral infiltrates with a reticulo-nodular pattern. Empiric cefepime and vancomycin were started. CTA revealed diffuse ground-glass opacities with intralobular nodules with septal-wall thickening, consistent with a nonspecific interstitial pattern. Intravenous dexamethasone was initiated for ILD of uncertain etiology. An autoimmune panel showed elevated rheumatoid factor and anti-CCP antibody. Fungal workup and quantiferon were negative. Cardiothoracic surgery performed a surgical lung biopsy, showing granulomata composed of histiocytes containing dust particles and intraalveolar organizing fibrin. Follow-up CT scan showed improvement consistent with steroid-responsive ILD. The patient was discharged on supplemental oxygen, a prednisone taper, bactrim prophylaxis for pneumocystis jirovecii pneumonia, and close follow-up with the multidisciplinary CT-ILD clinic. Discussion Silicosis is a progressive ILD associated with workplace exposure, including granite cutting (2). This case highlights a patient with numerous risk factors presenting with progressive shortness of breath and imaging showing a nonspecific interstitial pattern. The initial differential was broad, and a multidisciplinary approach was crucial for diagnosis and management. Disease pathology was steroid-responsive, with improvement in subsequent imaging; however, antibiotics covering superimposed bacterial pneumonia likely contributed. Prolonged workplace exposure is a major risk in silicosis development and has significant morbidity given the lack of targeted therapy (3). This patient demonstrates the importance of obtaining detailed social history to identify high intensity, prolonged occupational exposure when treating a patient with ILD, concerning for silicosis. This abstract is funded by: None