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Multiorgan accelerated silicosis misdiagnosed as sarcoidosis in two workers exposed to quartz conglomerate dust
  1. Gabriella Guarnieri1,
  2. Rosana Bizzotto2,
  3. Ottorino Gottardo2,
  4. Emanuela Velo3,
  5. Mauro Cassaro4,
  6. Stefania Vio5,
  7. Maria Grazia Putzu6,
  8. Federica Rossi6,
  9. Paolo Zuliani6,
  10. Filippo Liviero1,
  11. Paola Mason1,
  12. Piero Maestrelli1
  1. 1 Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
  2. 2 SPISAL – ULSS6 Euganea, Padova, Italy
  3. 3 Medicine Unit, ULSS 6 Euganea, Camposampiero, Italy
  4. 4 Pathology Unit, ULSS 6 Euganea, Camposampiero, Italy
  5. 5 Radiology Unit, University of Padova, Padova, Italy
  6. 6 Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
  1. Correspondence to Professor Piero Maestrelli, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova 35128, Italy; piero.maestrelli{at}


Introduction Clusters of silicosis cases have been reported in the fabrication of quartz conglomerate, a new high-silica-content artificial stone for kitchen and bathroom benchtops (countertops).

Aim We describe two cases of accelerated-type silicosis with hepatic granulomas arising in workers exposed to artificial quartz conglomerates.

Methods A confident diagnosis of multiorgan silicosis was based on high level of respirable silica in the workplace, typical radiological alterations in chest high-resolution CT, histological findings in the lung and liver, and detection of silica crystals in both tissues by phase-contrast polarising light microscopy and scanning electron microscopy and energy dispersive spectroscopy.

Results The development of the disease <10 years after the first exposure is consistent with an accelerated-type of silicosis. Compared with other studies related to quartz conglomerate exposure, we determined that the levels of airborne crystalline silica during activity in the finishing area were between 0.260 and 0.744 mg/m3, that is, much higher than the threshold limit value according to American Conference of Governmental Industrial Hygienists (0.025 mg/m3). Moreover, liver granulomas were associated with accumulation of crystalline silica particles in the hepatic tissue.

Conclusions Quartz conglomerate fabrication is a potentially dangerous occupation. General practitioners and physicians should have awareness of this newly described occupational hazard. Accurate occupational history is critical in avoiding misdiagnosis, as silicosis caused by inhalation of dust from artificial quartz conglomerates may exhibit atypical presentation. These features seem to be related to the extremely high level of silica exposure and, possibly, to an increased toxicity of the dust generated in this process.

  • liver
  • pneumoconioses
  • lung function
  • inorganic dusts
  • pathology

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  • Contributors Conception, literature search, hypotheses delineation, acquisition of the data or the analysis and interpretation of such information; writing the article or substantial involvement in its revision prior to submission: GG and PM. Acquisition, analysis and interpretation of data: All authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.