Clinical observation of a combination of sarcoidosis and silicosis in a mining and processing plant worker

Among the entire spectrum of respiratory pathologies in workers who come into contact with harmful industrial dust factors, those with pulmonary lesions deserve special attention. It should be remembered that in addition to pneumoconiosis, it is possible to develop other combined pulmonary pathology, including tuberculosis and sarcoidosis, which significantly complicates the differential diagnosis. In practical terms, doctors, especially occupational pathologists and pulmonologists, need to conduct a comprehensive full-fledged examination of patients with suspected occupational respiratory disease, paying special attention to various extrapulmonary lesions and the severity of inflammatory laboratory changes. Identification of the systemic nature of the pathology requires the exclusion of sarcoidosis — a disease of unknown etiology that occurs with granulomatous inflammation. In particularly difficult cases, it is necessary to perform morphological verification of the diagnosis with a thorough histological examination in a specialized expert institution. However, special difficulties may arise when a lung biopsy combines manifestations of pneumoconiosis and sarcoidosis, including the possibility of developing a so-called sarcoid reaction.

A clinical observation of rare comorbidity — sarcoidosis and silicosis — in a 38-year-old woman working at a mining and processing plant who was exposed to long-term exposure to silicon-containing dust in a concentration up to 14 times higher than the MPC is presented. The performed examination did not allow to clarify the cause of pulmonary dissemination, and therefore a lung biopsy was performed, which revealed a combination of sarcoidosis and pneumoconiosis in the patient. The importance of correct diagnosis is determined by the different choice of treatment tactics for these two diseases.

Funding. The study had no funding.

Conflict of interests. The authors declare no conflict of interests.

1. Mukhin N.A., Kosarev V.V., Babanov S.A., Fomin V.V. Occupational diseases. Moscow: GEOTAR-Media; 2016 (in Russian).

2. Izmerov N.F., Chuchalin A.G. Occupational respiratory diseases: national guideline. Moscow: GEOTAR-Media; 2015 (in Russian).

3. Rafnsson V, Ingimarsson O, Hjalmarsson I, and Gunnarsdottir H. Association between exposure to crystalline silica and risk of sarcoidosis Occup Environ Med. 1998; 55(10): 657–60.

4. Cheepsatt ayakorn A, Cheepsatt ayakorn R. Silicosis: biomarkers and pathogenesis. J Lung Pulm Respir Res. 2018; 5(5): 151‒3. DOI: 10.15406/jlprr.2018.05.00182.

5. Kira L. Newman, Lee S. Newman Occupational Causes of Sarcoidosis Curr Opin Allergy Clin Immunol. 2012; 12(2): 145–50. DOI: 10.1097/ACI.0b013e3283515173.

6. Hübener E, Kühne W, Scharkoff T. Coincidence of silicosis and sarcoidosis. 2. Relations between silicosis and sarcoidosis as well as forensic consequences. Z Erkr Atmungsorgane. 1986; 166 (2): 186–93.

7. Delphine Bourlier, Caroline O’Connell, David Montani, Laurent Savale, Andrei Seferian, Florence Parnt, Marc Humbert, Gérald Simonneau, Olivier Sitbon, Xavier Jaïs. A rare case of sarcoidosis-associated pulmonary hypertension in a patient exposed to silica. Eur Resp Rev. 2016; 25 (139): 93–6. DOI: 10.1183/16000617.0073–2015.

8. Vihlborg P. Risk of sarcoidosis and seropositive rheumatoid arthritis from occupational silica exposure in Swedish iron foundries: a retrospective cohort study. BMJ Open. 2017; 7: e016839. DOI:10.1136/bmjopen-2017-016839.

9. Quero A, Urrutia C, Martínez C, Rego G. Silicosis and sarcoid pulmonary granulomas, silicosarcoidosis? Med Clin (Barc). 2002; 26 (118 (2)): 79.

10. Syed Tousheed, Tiyas Sen, Hemanth Kumar, Muralimohan Bv Silicosis and Sarcoidosis: A Rare Association. Chest. 2014; 146 (4): 421A.