{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T12:06:29Z","timestamp":1782821189051,"version":"3.54.5"},"reference-count":36,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2023,8,22]],"date-time":"2023-08-22T00:00:00Z","timestamp":1692662400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Silicosis caused by the inhalation\/deposition of free silica particles is characterized by pulmonary inflammation\/fibrosis. Among the clinical disorders associated with silicosis, tuberculosis is by far the most prominent. A 66-year-old male non-smoker, originally from North Africa, reported a dry cough and significant weight loss. He was a foundry worker. He had a medical history of bladder carcinoma associated with schistosomiasis. Computed tomography (CT) and positron emission tomography (PET)\/CT showed bilateral multiple hypermetabolic lung nodules, some with cavitation. The patient underwent surgical resection of the largest nodule, which was highly suspicious of lung metastasis. The histological examination revealed multiple nodular formations. Several lesions showed the characteristic features of silicotic nodules. There were also adjacent well-formed granulomas, some with central caseous necrosis. A real-time polymerase chain reaction, performed for the identification and quantification of the DNA of the Mycobacterium tuberculosis complex, was positive. Pulmonary silico-tuberculosis is often encountered in patients with a history of silica exposure in tuberculosis-endemic areas. This case serves as a reminder to never underestimate patient occupational exposure and geographic origin. A careful histological diagnosis and molecular investigation are mandatory when approaching difficult cases, especially patients with a prior cancer history and clinical\/radiological features suggestive of tumour recurrence\/metastasis.<\/jats:p>","DOI":"10.3390\/diagnostics13172728","type":"journal-article","created":{"date-parts":[[2023,8,22]],"date-time":"2023-08-22T09:10:56Z","timestamp":1692695456000},"page":"2728","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A Complex Case of Pulmonary Silico-Tuberculosis and Review of Literature"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-4224-2622","authenticated-orcid":false,"given":"Lauren","family":"D\u2019Sa","sequence":"first","affiliation":[{"name":"Department of Histopathology, Addenbrooke\u2019s Hospital, Cambridge CB20QQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8023-3108","authenticated-orcid":false,"given":"Federica","family":"Pezzuto","sequence":"additional","affiliation":[{"name":"Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5792-4683","authenticated-orcid":false,"given":"Francesca","family":"Lunardi","sequence":"additional","affiliation":[{"name":"Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Scalvenzi","sequence":"additional","affiliation":[{"name":"Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariaenrica","family":"Tin\u00e8","sequence":"additional","affiliation":[{"name":"Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Comacchio","sequence":"additional","affiliation":[{"name":"Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0924-5883","authenticated-orcid":false,"given":"Chiara","family":"Giraudo","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Padova, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiorella","family":"Calabrese","sequence":"additional","affiliation":[{"name":"Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,22]]},"reference":[{"key":"ref_1","first-page":"4","article-title":"The ILO\/WHO global programme for the elimination of silicosis","volume":"12","author":"Fedotov","year":"2006","journal-title":"Occup. Health South Afr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1136\/oemed-2019-106321","article-title":"Trends in global, regional and national incidence of pneumoconiosis caused by different aetiologies: An analysis from the Global Burden of Disease Study 2017","volume":"77","author":"Shi","year":"2020","journal-title":"Occup. Environ. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2785","DOI":"10.1111\/all.14202","article-title":"Silica-related diseases in the modern world","volume":"75","author":"Hoy","year":"2020","journal-title":"Allergy"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.ejim.2010.02.004","article-title":"Rheumatoid pneumoconiosis (Caplan\u2019s syndrome)","volume":"21","author":"Schreiber","year":"2010","journal-title":"Eur. J. Intern. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"318","DOI":"10.3201\/eid1602.090824","article-title":"Concurrent silicosis and pulmonary mycosis at death","volume":"16","author":"Iossifova","year":"2010","journal-title":"Emerg. Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1460","DOI":"10.1164\/ajrccm.150.5.7952577","article-title":"The epidemiology of tuberculosis in gold miners with silicosis","volume":"150","author":"Cowie","year":"1994","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"100218","DOI":"10.1016\/j.jctube.2021.100218","article-title":"Mini-review: Silico-tuberculosis","volume":"23","author":"Lanzafame","year":"2021","journal-title":"J. Clin. Tuberc. Other Mycobact. Dis."},{"key":"ref_8","first-page":"1217","article-title":"Cases series on nontuberculous mycobacterial (NTM) lung disease and silicosis in Brazil","volume":"50","author":"Rangel","year":"2017","journal-title":"Eur. Respir. J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3069","DOI":"10.3389\/fimmu.2018.03069","article-title":"Immunity to the Dual Threat of Silica Exposure and Mycobacterium tuberculosis","volume":"9","author":"Ehrlich","year":"2019","journal-title":"Front. Immunol."},{"key":"ref_10","first-page":"455","article-title":"The relationship between tuberculosis and silicosis","volume":"118","author":"Snider","year":"1978","journal-title":"Am. Rev. Respir. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2785","DOI":"10.1038\/s41598-023-30012-4","article-title":"A mixed-methods study on impact of silicosis on tuberculosis treatment outcomes and need for TB-silicosis collaborative activities in India","volume":"13","author":"Rupani","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/0962-8479(95)90578-2","article-title":"Silicotuberculosis: Long-term outcome after short-course chemotherapy","volume":"76","author":"Cowie","year":"1995","journal-title":"Tuber. Lung Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1164\/ajrccm\/143.2.262","article-title":"A Controlled clinical comparison of 6 and 8 months of antituberculosis chemotherapy in the treatment of patients with silicotuberculosis in Hong Kong","volume":"143","author":"Service","year":"1991","journal-title":"Am. Rev. Respir. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1002\/ajim.23460","article-title":"Difficulties in distinguishing silicosis and pulmonary tuberculosis in silica-exposed gold miners: A report of four cases","volume":"66","author":"Maboso","year":"2023","journal-title":"Am. J. Ind. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e05482","DOI":"10.1002\/ccr3.5482","article-title":"Accelerated silicosis and silico-tuberculosis: A difficult diagnosis","volume":"10","author":"Khemakhem","year":"2022","journal-title":"Clin. Case Rep."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"103794","DOI":"10.1016\/j.amsu.2022.103794","article-title":"Deadly dust: Silicotuberculosis as a downplayed and overlooked fatal disease in Indonesia","volume":"78","author":"Djatioetomo","year":"2022","journal-title":"Ann. Med. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"121","DOI":"10.5603\/ARM.2018.0019","article-title":"Pulmonary tuberculosis in a male with silicosis","volume":"86","author":"Halicka","year":"2018","journal-title":"Adv. Respir. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.1513\/AnnalsATS.201702-163CC","article-title":"The limits of pattern recognition: Nodular lung disease in a Syrian refugee","volume":"14","author":"Lefkowitz","year":"2017","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e35","DOI":"10.1097\/LBR.0000000000000302","article-title":"Endobronchial silicosis and tuberculosis presenting as the right middle lobe syndrome","volume":"23","author":"Anderson","year":"2016","journal-title":"J. Bronchol. Interv. Pulmonol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"704","DOI":"10.5588\/ijtld.15.0742","article-title":"A rare adverse reaction to ethambutol: Drug-induced haemolytic anaemia","volume":"20","author":"Nicolini","year":"2016","journal-title":"Int. J. Tuberc. Lung Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"60","DOI":"10.4103\/0019-5278.183847","article-title":"\u201cBright asteroids in the polar sky\u201d\u2014Clinic-radio-pathological correlation in an unusual case of silicotuberculosis","volume":"20","author":"Rai","year":"2016","journal-title":"Indian J. Occup. Environ. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"bcr2015209315","DOI":"10.1136\/bcr-2015-209315","article-title":"An 11-year-old boy with silico-tuberculosis attributable to secondary exposure to sandstone mining in central India","volume":"23","author":"Murlidhar","year":"2015","journal-title":"BMJ Case Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1002\/ajim.22454","article-title":"Complicated silicotuberculosis in a South African gold miner: A case report","volume":"58","author":"Oni","year":"2015","journal-title":"Am. J. Ind. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"255","DOI":"10.4103\/1596-3519.122697","article-title":"Silicotuberculosis: Importance of evaluation of serial radiographs","volume":"12","author":"Sureka","year":"2013","journal-title":"Ann. Afr. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1111\/resp.12020","article-title":"Diagnosis of silicotuberculosis by Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA)","volume":"18","author":"Tung","year":"2013","journal-title":"Respirology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"54","DOI":"10.5152\/eajm.2012.12","article-title":"Co-existence of tuberculous meningitis and pulmonary tuberculosis in a denim sandblaster","volume":"44","author":"Ozden","year":"2012","journal-title":"Eurasian J. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"536","DOI":"10.2298\/SARH1108536M","article-title":"Silicotuberculosis and silicosis as occupational diseases: Report of two cases","volume":"139","author":"Nowak","year":"2011","journal-title":"Srp. Arh. Celok. Lek."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"293730","DOI":"10.1155\/2010\/293730","article-title":"Cavitated conglomerate mass in silicosis indicating associated tuberculosis","volume":"2010","author":"Martins","year":"2010","journal-title":"Case Rep. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"241","DOI":"10.4081\/monaldi.2004.689","article-title":"Silicotuberculosis in the elderly: Report of two cases","volume":"61","author":"Scafa","year":"2004","journal-title":"Monaldi Arch. Chest Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1183\/09031936.03.00115102","article-title":"Lymphoepithelioma-like carcinoma of the lung in a patient withsilicosis","volume":"22","author":"Ho","year":"2003","journal-title":"Eur. Respir. J."},{"key":"ref_31","first-page":"101","article-title":"Silicosis in a housewife","volume":"24","author":"Safa","year":"2003","journal-title":"Saudi Med. J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1378\/chest.75.2.202","article-title":"Silicosis and Tuberculosis","volume":"75","author":"Morgan","year":"1979","journal-title":"Chest"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1378\/chest.72.5.635","article-title":"Silicosis in workers dealing with tonoko: Case reports and analyses of tonoko","volume":"72","author":"Kawakami","year":"1977","journal-title":"Chest"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1164\/rccm.2111028","article-title":"Sensitivity of acid-fast staining for Mycobacterium tuberculosis in formalin-fixed tissue","volume":"166","author":"Fukunaga","year":"2002","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_35","first-page":"327","article-title":"Comparison of the Xpert MTB\/RIF assay and real-time PCR for the detection of Mycobacterium tuberculosis","volume":"1","author":"Kim","year":"2015","journal-title":"Ann. Clin. Lab. Sci."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1186\/rr54","article-title":"The molecular basis of resistance to isoniazid, rifampin, and pyrazinamide in Mycobacterium tuberculosis","volume":"2","author":"Somoskovi","year":"2001","journal-title":"Respir. Res."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/17\/2728\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:39:32Z","timestamp":1760128772000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/17\/2728"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,22]]},"references-count":36,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2023,9]]}},"alternative-id":["diagnostics13172728"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13172728","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,22]]}}}