Deadly dust: Silicotuberculosis as a downplayed and overlooked fatal disease in Indonesia

BACKGROUND: Silicosis is one of the most common diseases among all occupational diseases. The main clinical focus on the silicosis complication will be tuberculosis. CASE PRESENTATION: A 28-year-old male presented with complaints of chronic dry cough, weight loss, decreased appetite, and night sweats. The patient worked in the synthetic leather factory for 7 years and rarely used proper protective equipment. Chest X-ray showed bilateral fibroinfiltrate as a sign of a specific process in the lungs. Thoracic HRCT suggested an infected cystic type of bronchiectasis. Bronchoalveolar lavage from bronchoscopy was performed. The result of the silica spectrophotometric test and GenXpert BAL was both positive for silicosis and tuberculosis, consecutively. The patient has been diagnosed with an occupational lung disease accompanied by tuberculosis complications, namely silicotuberculosis. The patient received tuberculosis therapy and was advised to an early retirement due to disability. DISCUSSION: The duration and level of intensity of exposure, as well as the severity of silicosis, are factors of tuberculosis. The silicosis diagnosis can be made from occupational history or silica exposure, as well as appropriate radiological and histopathological findings. CONCLUSION: Silicotuberculosis is a disease due to silica exposure, and is often found in TB endemic countries.