A Case Report of Co-existence of Chronic Silicosis and Pulmonary Tuberculosis in an Active Smoker

Introduction: Silicosis is an occupational lung condition that can lead to permanent physical disability, primarily due to inflammation, scarring of lung tissue, and breathing difficulties. In regions with high rates of tuberculosis (TB), such as South Asia, the presence of TB accelerates the development of pulmonary fibrosis. Additionally, smoking significantly increases the likelihood of further lung damage. Case Presentation: This case report presents a 65-year-old gentleman who presented to the Department of Pulmonology, Bahawal Victoria Hospital, Bahawalpur, with exertional shortness of breath for 6 months, which worsened in the last month to the extent that he experienced dyspnea at rest. This was associated with a productive cough and yellowish sputum for 3 weeks. He had a past history of pulmonary TB 4 years ago and was an active smoker with a 30-pack-year history. He had worked in a stone-crushing factory for the last 35 years but was unable to work in the last few months due to his illness. His chest X-ray and high-resolution computed tomography (HRCT) demonstrated loss of lung volume bilaterally, diffuse nodularity with ground-glass opacifications, bulky hilum, and a left upper lobe fibro-cavitary lesion. Sputum examination was positive for acid-fast bacilli (AFB) stain, and GeneXpert MTB/RIF PCR confirmed the presence of Mycobacterium TB but showed no drug resistance. Based on clinical and radiographic findings, he was diagnosed with active pulmonary TB (relapse) with underlying chronic silicosis by the pulmonology team and managed with supportive oxygen inhalation therapy, category II anti-TB therapy, smoking cessation counseling, and occupational rehabilitation. Conclusions: This case underscores the significance of coexisting silicosis and TB, especially in individuals with a significant smoking history and occupational exposure to silica. This report emphasizes the importance of early detection, multidisciplinary management, and comprehensive treatment strategies, including anti-TB therapy, smoking cessation counseling, and occupational rehabilitation, to improve patient outcomes in complex cases with overlapping lung diseases.