A 45-year-old male with a history of hypertension, type 2 diabetes mellitus, cutaneous psoriasis, right basal pneumonia for 6 months and septorhinoplasty for 5 years due to nasal septum deviation.
Since the intervention, the patient had continuous nasal dryness, which is why he used oily nasal drops daily.
Primary care was provided to the internal medicine department due to persistent dry cough for 3 months.
Physical examination revealed only a decrease in vesicular murmur at the right base with subcrepitants at that level.
Pulmonary function tests showed a moderate restrictive pattern.
The chest X-ray showed an increase in density in the right lung base compatible with an alveolar pattern of chronic evolution.
Chest computed tomography showed a small condensation image in the right upper lobe, at the carina level and a condensation image in the right posterior fossa with an inflammatory bronchogram, both images compatible with lesions.
After performing the biopsy described, it was decided to perform a transthoracic needle aspiration biopsy (fibrorebAF) of one of the most accessible condensation areas, which is negative for obtaining insufficient sample.
Anatomopathological examination of the samples (transbronchial biopsy) reports the presence of macrophages with intracytoplasmic lipid vacuums.
All microbiological investigation techniques were negative.
The "nasal drips" were removed.
At 6 months the patient was clinically better, although the control X-ray was similar to the previous ones.
It was decided to start treatment with oral glucocorticoids (prednisone) at doses of 1.5 mg/kg/day for 12 weeks, with progressive decrease, up to a maintenance dose of 0.2 mg/kg/day.
One year later, a significant radiological improvement was observed and even functional tests improved considerably.
