Silicosis, Sarcoidosis, and Silicosarcoidosis Are Overlapping Diagnoses and Difficult to Differentiate.

We evaluated 12 workers with documented exposure to respirable crystalline silica who were referred to a tertiary care center due to clinical suspicion of silicosis, sarcoidosis, or silicosarcoidosis. Although silica exposure is a well-established risk factor for silicosis and has been associated with autoimmune diseases, mycobacterial infections, and lung cancer, growing evidence also suggests a link with sarcoidosis, creating important diagnostic and therapeutic challenges. All patients underwent at least two clinical evaluations, high-resolution computed tomography (HRCT), and pulmonary function tests over a minimum follow-up of 12 months. Diagnostic classification was based on predefined criteria integrating occupational exposure history, longitudinal clinical course, HRCT patterns, pulmonary function changes, and histopathology when available; ten patients underwent transbronchial biopsy and six bronchoalveolar lavage. Three patients were classified as having silicosis, five as sarcoidosis, and four as silicosarcoidosis. Despite comparable exposure histories, the groups demonstrated distinct radiologic features, functional trajectories, and responses to therapy. Overlapping HRCT findings and the absence of standardized diagnostic criteria contributed to classification challenges, particularly in cases with mixed granulomatous and fibrotic patterns. In silica-exposed workers, although silicosis remains the most frequent diagnosis, distinguishing it from sarcoidosis and silicosarcoidosis requires systematic longitudinal assessment. The integration of occupational history with serial clinical, radiologic, functional, and histopathologic evaluation enhances diagnostic accuracy and supports appropriate therapeutic decision-making.