Regulations to control of exposure to silica have existed in Australia since the 1930s, but hazard awareness is imperfect. To highlight the dangers of exposure to respirable silica dust, we describe a case of silicosis in a 52 year man whose exposure to silica was cutting and polishing engineered stone kitchen and bathroom countertops. The man presented with breathlessness, later complicated by bilateral spontaneous pneumothoraces requiring tube thoracostomies, and now requires lung transplantation. An Australian man worked as a stone cutter for >20 years. Conditions were dusty. He used a paper mask irregularly in the later years. There was no health screening and only minimal dust extraction measures. He smoked 20 cpd for 20 years. He noticed breathless and cough in 2006 and was diagnosed with emphysema; after haemoptysis he was referred for specialist advice and tuberculosis was excluded. Lung function showed severe airflow obstruction with gas trapping and a DLCO of 40% predicted. A lung biopsy confirmed silicosis. CT is shown.

He subsequently presented with bilateral non-contemporaneous pneumothoraces. This is the first case of silicosis associated with engineered stone described from Australia. This shows that silicosis still occurs despite occupational health & safety regulations in developed countries. Such regulations are only as good as their implementation.