Splenic silicosis, a rare extrapulmonary manifestation of occupational silica exposure: A case report

INTRODUCTION: Silicosis is a well-recognised occupational lung disease caused by inhalation of crystalline silica dust; however, extrapulmonary involvement, particularly splenic silicosis, remains rare and underreported in the literature. CASE PRESENTATION: A 46-year-old female sand sifting machine operator presented with six years of occupational silica exposure at a sand classification and packing factory. In 2005, she developed respiratory symptoms, and chest radiography revealed diffuse nodular opacities, although silicosis was not diagnosed at that time. In October 2024, approximately 19 years after initial presentation, computed tomography demonstrated multiple calcified pulmonary nodules, progressive massive fibrosis, eggshell calcification of mediastinal lymph nodes, and multiple calcified micronodules throughout the splenic parenchyma. Based on these characteristic radiological findings and her occupational exposure history, a diagnosis of complicated silicosis with extrapulmonary splenic involvement was established. Despite a latency period shorter than the traditionally reported 10-30 years for chronic silicosis, the clinical course was indolent across the interval between the two assessments (2005 and 2024), which may lie near the boundary between chronic and accelerated forms. CONCLUSIONS: Splenic silicosis should be considered in patients with occupational silica exposure who present with splenic calcifications. Although sand sifting operations have received limited attention as a potential source of silica exposure, the occurrence of multiple cases at the same facility suggests potentially high exposure intensity. These findings emphasise the importance of comprehensive prevention strategies and raise the question of whether earlier initiation of health surveillance may benefit workers in sand processing industries.