Silicosis Diagnosed Using Transbronchial Lung Biopsy: The Pivotal Role of Occupational History.

Pulmonary silicosis, a preventable occupational lung disease caused by chronic inhalation of crystalline silica dust in industries like construction, mining, and stone masonry, remains underdiagnosed in TB-endemic regions due to overlapping clinical and radiological features. A 63-year-old man presented with upper gastrointestinal bleeding, but a silent lung abnormality stole the clinical spotlight. In a TB-endemic setting, incidental reticulonodular opacities triggered a full tuberculosis work-up, even in the absence of cough or respiratory symptoms. Yet it was only after a delayed occupational history revealed three decades of unprotected mosaic tiling that silicosis was considered. High-resolution CT and transbronchial lung biopsy later confirmed the diagnosis, but not before the patient's course was complicated by obstructive uropathy and sepsis. This case highlights the diagnostic pitfalls of radiologic overlap between silicosis and tuberculosis, as well as the crucial role of occupational exposure history in reaching the correct diagnosis.