Silicosis is one of the oldest occupational diseases, known since the time of Hippocrates, and the diagnosis can be established after a latency time of more than 10 years after exposure cessation. In some cases of chronic silicosis, the disease can progress slowly, evolving over several decades, but it can also evolve into massive pulmonary fibrosis, also known as accelerated silicosis. Furthermore, in extremely rare cases, the disease can present a rapid progression into acute silicosis or silicoproteinosis. The present article gives a deeper view into silicosis and secondary massive progressive pulmonary fibrosis, as well as the difficulties encountered in the management of such patients. We present two different but similar cases that underline the importance of a precise diagnosis, pointing out the long latent period after the exposure to silicon-dioxide, more than 15 years in both cases. This accelerated form of silicosis associated with massive pulmonary fibrosis progressed in 2 years into respiratory failure in both cases.