A 45-year-old stone quarry worker presents with progressive dry cough and exertional dyspnoea over years. Chest radiograph shows bilateral upper zone small rounded opacities with hilar lymph nodes showing peripheral rim-like calcification. He also gives a history of recurrent fever episodes treated as tuberculosis in the past. Which complication is he at markedly increased risk of?

• A Pulmonary tuberculosis ✓
• B Primary lung adenocarcinoma
• C Mesothelioma
• D Bronchial asthma

Explanation

Eggshell calcification of hilar nodes with upper zone micronodules in a quarry worker is silicosis. Crystalline silica impairs macrophage function and destroys phagolysosomes containing mycobacteria, so silicosis confers a markedly increased risk of pulmonary tuberculosis, and past febrile episodes may have been occult TB. Mesothelioma relates to asbestos, not silica. Silica exposure is linked to lung cancer overall but the classic examined association, and the one this vignette points to, is tuberculosis.

Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.