Acute Silicosis Responding to Corticosteroid Therapy

"The risk of developing silicosis in underground coal miners, tunnel workers and some foundry workers is well-known. These persons generally develop the classic form of the disease over a prolonged period of time. Workers involved in abrasive blasting of bridges and those polishing tombstones have been reported to develop an acute form of silicosis within a few years of commencing exposure. Not well-appreciated is the potential for development of acute silicosis among drillers at surface coal mines. We report the case of a 33-year--old man who worked primarily at surf ace drilling, developed acute silicosis within three years of beginning exposure, and who initially responded dramatically to corticosteroid therapy. CASE REPORTThe patient is a 33-year-old white man who worked as a rock driller at a quarry and also at surface coal mines in western Pennsylvania since 1975. Prior to 1983, much of his work was done with a wet process in which water was applied to reduce dust generation. After 1983 he worked primarily as a driller at a surface coal mine using a dry process. He never wore a respirator. He described the dust as being so dense that he ""couldn't see anything.- In August 1986, he presented to his local physician with a complaint of pleuritic chest pain and shortness of breath. A chest x-ray film was obtained showing only a few p and q opacities. He continued working and these symptoms subsided, but the patient noted the onset of progressive weight loss. By May 1987, he had lost approximately 50 lb. In addition, he suffered profound malaise, dyspnea, migratory chest pain and arthralgia, fevers and drenching night sweats.A course of erythromycin therapy given in the hospital resulted in only fleeting improvement. Studies for Legionella and Mycoplasma infections were negative, as was a tuberculin skin test. The patient was transferred to Allegheny General Hospital in Pittsburgh on June 4, 1987.There was no history of serious medical illness, including tuber¬culosis. The patient admitted to smoking between I and 1 1/2 packages of cigarettes daily for 2 1/2 years prior to May 1987 when he stopped smoking. He denied intravenous drug abuse, homosexual activity or receiving transfusions of blood or blood products.On physical examination the patient was a thin, febrile white man who appeared chronically ill. Bilateral axillary and cervical lymphadenopathy was present. Chest examination showed restricted expansion and bilateral crackles. Examination of the heart and abdomen disclosed no abnormalities."