Confronting the Silent Threat of Pneumoconiosis in Informal Mining: Two Case Reports and Literature Review

Abstract Background: Pneumoconiosis poses a significant public health challenge among artisanal and small-scale miners due to inadequate prevention of workplace dust, delayed diagnosis, and limited treatment options. In tuberculosis-endemic settings, the disease is frequently mistaken for pulmonary tuberculosis, leading to inappropriate treatment and delayed recognition. Reports describing advanced pneumoconiosis among artisanal miners in Tanzania remain scarce despite the rapid expansion of informal mining. This report presents two fatal cases to highlight important diagnostic challenges, uncommon clinical manifestations, and lessons for clinical practice. Case presentation: We describe two African men aged 30 and 34 years admitted to Katavi Referral Regional Hospital between December 2024 and March 2025 after 11 and 4 years of artisanal gold mining, respectively. Both presented with progressive dyspnea, chronic cough, hypoxemia, and marked weight loss and had initially been treated empirically for tuberculosis despite negative microbiological investigations. Chest computed tomography (CT) demonstrated progressive massive fibrosis consistent with complicated pneumoconiosis, while one patient had the uncommon finding of silica-associated constrictive pericarditis with pericardial calcification. Both patients received supportive treatment comprising oxygen therapy, corticosteroids, bronchodilators, antibiotics, and pulmonary rehabilitation; however, they developed progressive respiratory failure and died during hospitalization. Clinical discussion: The reported cases illustrate that advanced pneumoconiosis may develop after relatively short occupational exposure, continue to progress even after mining exposure has ceased, and closely mimic pulmonary tuberculosis in high-burden settings. They also highlight the diagnostic value of obtaining a detailed occupational history and performing chest CT when tuberculosis investigations are negative or when patients fail to respond to treatment. Furthermore, the report documents a rare cardiovascular manifestation of constrictive pericarditis associated with silica exposure. Conclusion: These cases contribute to the limited literature on pneumoconiosis among Tanzanian artisanal miners and underscore the need for early diagnosis through occupational history taking, timely chest evaluation, and strengthened occupational health surveillance to reduce diagnostic delays and prevent advanced disease.