Systemic sclerosis associated with silicosis in an agricultural worker: A case of Erasmus syndrome

Abstract

Erasmus syndrome is a rare entity defined by the association of systemic sclerosis and documented silica exposure, with or without established silicosis. A thoraco-abdominopelvic CT scan, performed during surveillance of treated ovarian carcinoma in a 59-year-old woman, revealed multiple calcified micronodules, mediastinal and hilar lymph node calcifications with an "egg-shell" pattern, traction bronchiectasis, and esophageal dilatation, suggesting silicosis. A directed history disclosed more than 30 years of non-industrial agricultural exposure to silica-rich dust during manual processing of lentils and beans in a desert region. Serologic testing demonstrated high-titer anti-Scl-70 antibodies, confirming systemic sclerosis and supporting the diagnosis of Erasmus syndrome. This case highlights the pivotal role of thoracic CT in detecting characteristic silicotic patterns and illustrates how imaging can prompt targeted occupational anamnesis in non-industrial exposure settings.