A 43-year-old quarry worker, after being exposed to fine quartz dust for 16 years in a German quarry, is on the waiting list for a lung transplant. The inhalation of the fine dust irreversibly damaged his lungs and facilitated the occurrence of fulminant mycobacterial and fungal infections, which have already led to a unilateral pneumonectomy and increasing respiratory failure. Despite regular monitoring by the occupational health and safety board, this dramatic development of silicosis could not be prevented.