A 32-year-old gentleman, a worker in a cement-manufacturing facility with suspected silica-induced lung disease presented with acutely worsening Type 1 respiratory failure. With a negative work-up for infectious causes and no further revelations on bronchoalveolar lavage fluid or endobronchial biopsy, it was a transbronchial biopsy that ultimately led us to a diagnosis of silicoproteinosis with accelerated silicosis. Interestingly, the patient had a pleural effusion which on thoracentesis showed chylous fluid-the first reported case of chylothorax in association with silicosis.