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Annals of Occupational and Environmental Medicine

, 29:18

First Online: 19 June 2017Received: 05 January 2017Accepted: 15 June 2017DOI: 10.1186-s40557-017-0176-x

Cite this article as: Kim, J.Y., Do, S.Y., Moon, Y.H. et al. Ann of Occup and Environ Med 2017 29: 18. doi:10.1186-s40557-017-0176-x


BackgroundOccupational exposure to crystalline silica is a potential risk factor for various systemic autoimmune diseases including systemic sclerosis. The etiology of systemic sclerosis is not conclusively known, but there are epidemiological studies that show the relationship between exposure to crystalline silica and risk of systemic sclerosis. Here we report, for the first time, two cases of crystalline silica-related systemic sclerosis in patients who worked in crystal processing in the jewelry-manufacturing field.

Case presentationCase 1 is a 57-year-old man who had worked mainly in crystal processing for multiple jewelry-processing companies for 17 years, since the age of 15 years. He contracted tuberculosis at the age of 25 years and showed Raynaud’s phenomenon of both the hands and feet at age 32 years. Digital cyanosis and sclerosis developed at approximately age 41 years. The patient was diagnosed with systemic sclerosis at age 48 years.

Case 2 is a 52-year-old man who worked in crystal processing for various jewelry-processing companies for 7 years, since the age of 23 years. He first showed signs of cyanosis in the third and fourth digits of both hands at age 32 years, was diagnosed with Raynaud’s syndrome at age 37 years, and was diagnosed with systemic sclerosis at age 38 years.

Crystal processing is a detailed process that involves slabbing and trimming the selected amethyst and quartz crystals, which requires close proximity of the worker’s face with the target area. In the 1980s and 1990s, the working hours were 12 h per day, and the working environment involved 15 workers crowded into a small, 70-m space with poor ventilation.

ConclusionTwo workers who processed crystals with a maximum crystalline silica content of 56.66% developed systemic sclerosis. Considering the epidemiological and experimental evidence, exposure to crystalline silica dust was an important risk factor for systemic sclerosis. An active intervention is necessary to reduce exposure in similar exposure groups in the field of jewelry processing.

KeywordsCrystalline silica Jewelry Systemic sclerosis Occupational exposure Korea AbbreviationsACR-EULARAmerican College of Rheumatology-European League Against Rheumatism Collaborative Initiative

Anti-CCP AbAnti-cyclic citrullinated peptide antibody

ARAAmerican Rheumatism Association

CERRCombined estimator of relative risk

CPFECombined pulmonary fibrosis with emphysema

CRPC-reactive protein

ESRErythrocyte sedimentation rate

FANAFluorescent antinuclear antibody

GTCSGeneralized tonic-clonic seizure

KCOMWELKorea Workers’ Compensation and Welfare Service

PASPPulmonary artery systolic pressure

RBCRed blood cell

SMRStandardized mortality rate

SRRStandardized ratio rate

TSHThyroid-stimulating hormone

WBCWhite blood cell



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