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(known to induce lung fibrosis) or any family history of similar ailments, a final etiological diagnosis of Erasmus syndrome (diffuse cutaneous systemic sclerosis associated with silica exposure) was made and no alternative possibility was entertained. Treatment was made with Prednisone (40 mg/day based on body weight 38 kg, to be continued lifelong) and cyclophosphamide (1 g/month pulse dosage for 6 months) for ILD and Nifedipine (started with 20 mg/day and increased up to 120 mg/day over 6 months and advised to continue lifelong) for PHT and Raynoud��s phenomenon. Advice was given to strictly avoid cold exposure and attend regular follow-up in OPD. He was found to have significant improvement in skin tightening, arthralgia, Raynaud��s phenomenon and cough although marginal improvement in dyspnoea over treatment for 6 months during follow-up visit. Discussion Systemic sclerosis is an autoimmune disease with vascular changes and inflammation and degeneration with diffuse tissue fibrosis involving skin, lung, kidney, heart, PLX-4720 gastrointestinal tract, and synovium [1]. Although pathology has been elucidated in recent studies, exact pathogenesis is still enigmatic. Environmental and occupational exposures have been implicated in some studies, namely vinyl chloride, epoxy benzene, organic solvent, silica [2]. Silicosis is probably the most common form of pneumoconiosis, caused by the inhalation of mineral dust containing silica. Silicosis is an inflammatory disease of the lung characterized by irreversible lung fibrosis which develops from prolonged pulmonary inhalation and retention of crystalline silica and immune reaction mounted by the body to this extraneous chemical. It mainly appears as an occupational hazard in persons involved in stone-quarrying, mining and sand blasting [3]. Silicosis is often associated with the development of other diseases, such as pulmonary tuberculosis, lung carcinoma and less commonly, autoimmune diseases like systemic sclerosis (SSc), rheumatoid arthritis and systemic lupus erythematosus [4]. Exposure to silica is associated with abnormalities of the humoral and cellular immunity, hypergammaglobulinemia and alterations in T-helper and T-suppressor lymphocytes; antinuclear antibody and rheumatoid factor often become positive [5].