Pneumoconiosis mimicking pulmonary tuberculosis in a TB-endemic region—a case report

Abstract In regions with a high burden of tuberculosis (TB), distinguishing pulmonary tuberculosis from other chronic interstitial lung diseases remains diagnostically challenging. Pneumoconiosis, a chronic occupational lung disease caused by prolonged inhalation and retention of mineral dust particles—most commonly among gold mining and stone cutting workers—results in diffuse pulmonary fibrosis and may closely resemble TB on both clinical and imaging grounds. In gold miners, chronic exposure to silica-containing dust leads to alveolar macrophage activation, persistent inflammation, and fibrotic remodeling of the lung parenchyma, producing radiological features that can mimic granulomatous infections such as tuberculosis. Recent studies have emphasized the diagnostic value of high-resolution computed tomography (HRCT) in recognizing characteristic radiologic patterns, particularly the perilymphatic distribution of nodules and calcified lymphadenopathy, which can help differentiate pneumoconiosis (silicosis) from infectious or granulomatous diseases.