Isolated Sclerodactyly Associated with Silica Exposure in a Stonemason: A Case Report.

INTRODUCTION: Sclerodactyly is commonly associated with systemic sclerosis (SSc), occurring alongside Raynaud's phenomenon and disease-specific autoantibodies. The combination of occupational silica exposure and SSc is known as Erasmus syndrome. However, isolated digital fibrosis in silica-exposed individuals without systemic features or SSc-specific autoantibody positivity has not yet been described.

CASE PRESENTATION: A 40-year-old stonemason presented with a 6-month history of progressive fingertip sclerosis, fissuring, and pain, in combination with hand dermatitis, which was initially diagnosed and treated as hand dermatitis alone. Examination revealed distal digital tapering, loss of skin markings, telangiectasia, and abnormal nailfold capillaries, together with dermatitis, without Raynaud's phenomenon or systemic involvement. High-resolution computed tomography demonstrated upper-lobe-predominant pulmonary nodules consistent with chronic silicosis. Autoimmune serology showed a weakly positive antinuclear antibody of 1:80 with negative SSc-specific autoantibodies. Under the 2013 ACR-EULAR criteria, the patient did not meet the diagnostic threshold for SSc. Dermatitis improved with exposure cessation and topical tacrolimus therapy, while sclerodactyly persisted.

CONCLUSION: This case highlights isolated sclerodactyly as a potential manifestation of silica exposure in the absence of SSc or disease-specific autoantibodies. In this case, it permitted earlier detection and management of silicosis. Given the potential for progression to SSc, early identification and multidisciplinary surveillance may help prevent progression and associated morbidity.