Clinical improvement of acute silicosis due to corticosteroid treatment was reported in the case of a rock driller. The 33 year old patient had worked as a quarry rock driller and at surface coal mines in western Pennsylvania for about 10 years. His work involved wet processing for dust reduction prior to 1983, but dry processing after 1983. A respirator was never worn. In August of 1986, an X- ray was performed in response to complaints of chest pain and shortness of breath; it revealed only a few opacities. The patient continued working and the symptoms subsided, but he experienced progressive weight loss. By May of 1987 he had lost 50 pounds and suffered profound malaise, dyspnea, migratory chest pain and arthralgia, fevers, and drenching night sweats. A dramatic but transient response to corticosteroid therapy was seen; however, later chest radiography and pulmonary function tests indicating deterioration to category-A complicated silicosis.