P-499 Accelerated Silicosis in a Stonemason – How Many Cases Do We Need to Learn the Lesson?

Stonemasons are at high risk of silicosis: they generally work on a contract basis, in small enterprises, with minimal protective measures and due to frequent changes in employers might skip the continuity of an occupational medicine surveillance. We present a case of a 32 years old men, who was heavily exposed to natural stones (including granite) as stonemason for 9 years and was never refered to a specialized clinic of occupational medicine for the mandatory annual checkup. He start working since he was 16 years old in a small workshop. The main activities were cutting, griding and polishing natural stones without protective equipment and no aspiration system. In 2016 he was admitted in a pulmonology clinic for dispnea, mialgia and arthralgia.. This diagnosis of tuberculosis was ruled out after several negative sputum results. Lung and mediastinium ganglia biopsies were performed and confirmed the presence of the silicotic nodules and extensive fibrosis. He was treated with systemic corticoid for cough and dyspneea exacerbation, but the clinical status progressively deteriorate. In 2022, he had a spontaneous pneumothorax. In June 2023, due to the severe mixed ventilatory disfunction (FVC=26%, FEF1 =16% and FEF1/CV = 50.4%, TLC = 37%), DLCO=5.77 mmHg (16%) he was proposed for the pulmonary transplant. This case highlights the need for prevention in small enterprises and the desastrous consequences of ignoring the exposure. This message has to pass to employees and employers, authorities and all the ones involved in occupational risk management in order to stop cases like this one to happen.