A 23-year-old male smoker of 1-2 cigarettes/day, with no comorbidities, asymptomatic respiratory, in a preoccupational health control underwent chest X-ray that revealed bilateral tenuous interstitial infiltrate of nonspecific character.
He did not report general malaise, fever, asthenia, fatigue, dyspnea, chest pain, cough, sputum or hemoptysis.
He did not report exposure to birds, drugs or toxic gases.
In childhood he was treated for acute glomerulonephritis post-streptococcal infection and acute hepatitis.
On physical examination, the patient showed good general condition, mesomorph, normal vital signs and 98% SpO2 with room air.
Well hydrated, no skin or mucosal lesions.
No lymphadenopathies were detected.
He had no head or neck injuries.
Chest: no external lesions, symmetrical expansion and normal sonority, pulmonary murmur preserved without added noises.
cardiac normal.
No alterations in the abdominal examination were observed. No masses or visceromegaly were observed.
No limb injuries or axial skeleton, showed no edema or digital clubbing.
At the initial consultation, a high resolution computed tomography of the chest was performed, which showed multiple small cystic structures with poorly defi ned walls, predominantly in the upper lobes, associated with small nodules of centrilobular distribution.
There were no mediastinal lymph nodes or bone or soft tissue lesions.
The diagnosis of pulmonary histiocytosis was raised and a fibrobronchoscopy was performed, which showed no alterations of the bronchial mucosa, and a transbronchial biopsy that showed infi ltrated pulmonary lymphocyte accumulation.
Immunohistochemistry with monoclonal antibodies showed positive reaction for CD1a antigen, which supported the diagnosis of HPCL.
1.
Laboratory tests and respiratory function assessment are described in Table 1.
He had no anemia, leukocytosis, elevated ESR, or impaired renal or hepatic function.
Pathologic examination revealed mild bronchial obstruction resettlement with bronchodilator.
Lung volumes, DLCO and 6-minute walk test were within the normal range.
