Unveiling Risk Factors in a Patient with Silicotuberculosis: A Case Report

Introduction: Silicosis, an occupational lung disease caused by crystalline silica dust, is often complicated by tuberculosis. The epidemiological triad suggests that disease results from imbalanced interactions between the host, agent, and environment.

Case: A 63-year-old underweight male presented with decreased consciousness after swallowing capsules, chronic cough, low-grade fever, weight loss, and lower urinary tract symptoms. The patient had a medical history of smoking, drug abuse, and alcohol consumption. He had worked as a construction worker for 33 years without personal protective equipment (PPE). The patient lived in a substandard housing, and three neighbors had a history of tuberculosis (TB). Urine toxicology was positive for amphetamines, while abdominal ultrasound showed prostate enlargement. A chest X-ray showed fibroinfiltrates, cavities, and reticulogranular patterns. A high-kV chest X-ray revealed profusion levels of 1/2 S/S and 1/1 P/P. Contrast chest CT showed tree-in-bud patterns, reticulogranular patterns, small nodules, and fibrosis, while brain CT was normal. GeneXpert sputum confirmed Mycobacterium tuberculosis and bronchoalveolar lavage (BAL) spectrophotometric detected 38.90 ppm silica. The patient was diagnosed with amphetamine intoxication, benign prostatic hyperplasia, and silicotuberculosis. Haloperidol, tamsulosin, and anti-tuberculosis therapy were administered, although no specific treatment was administered for silicosis. He was advised to transition to a job with minimal silica exposure and planned to receive housing renovation assistance from the Health Office of Surabaya City. The patient was declared cured after completing six months of TB treatment.

Conclusion: The host factors included nutritional status, comorbidity, and personal habits; the agent factor was Mycobacterium tuberculosis; and the environmental factors included inadequate ventilation, high housing density, close contact with TB patients, and occupational conditions. A holistic identification of host, agent, and environmental risk factors is essential for understanding the development, prevention, and diagnosis of silicotuberculosis.