Artificial Stone Silicosis: the first UK case series

<bold>Introduction</bold> Outbreaks of silicosis from exposure to artificial stone (AS) have been reported in several countries since 2010. In the last year the first definite cases of AS silicosis have been seen in the UK. <bold>Aim</bold> To describe occupational exposures and clinical features of incident cases of AS silicosis referred to a single specialist UK occupational lung disease clinic. <bold>Methods:</bold> A retrospective case note review of patients with silicosis and occupational exposure to AS was carried out. <bold>Results:</bold> 7 male patients with silicosis due to possible (n=2; seen in 2017 and 2018) or definite (n=5; all seen in 2023) AS exposure were identified. Of the 7, median age was 31 (range 27-56y) and 5 were born outside the UK. There were 2 current, 1 never and 3 ex-smokers. Median duration of exposure to any stone dust was 17 years; 4 had mixed stone exposures (range 17-21y) which included AS exposure (range 6-10y). Three cases had only ever worked with AS, with exposure histories of 3-5 years. All reported dry cutting and polishing of AS worktops without appropriate respiratory protection. None had access to occupational health surveillance. Radiology showed simple silicosis (n=3), progressive massive fibrosis (n=3) and silicoproteinosis (n=1). Elevated serum ACE, positive ANA and lymphopenia were common features. 5 had non-caseating granulomata on biopsy. Treatment varied but included immunosuppression and whole lung lavage. Two had confirmed infection with non-tuberculous mycobacteria. One patient is deceased; two were referred for lung transplantation. <bold>Conclusion:</bold> Urgent action must be taken to identify cases of AS silicosis in the UK, legislation enforced to control workplace exposures to AS and a ban of AS introduced as planned in Australia.