We report the case of a 35-year-old man who attended the outpatient clinic for evaluation of chest X-ray abnormalities.
She had no drug allergies, was allergic to pollen.
As a profession he worked by putting panels of pladur.
He smoked 10 cigarettes/day from 14 years of age (10.5 packs/year) and 8 pearls of marijuana/day.
He used alcohol occasionally.
She had no family history of interest.
Interrogate reported in the last year coughing predominantly evening and night with supine decubitus, accompanied by white expectoration.
He also had associated wheezing that improved with bronchodilators.
He also complained of dyspnea on exertion.
He had lost about 5 kg of weight.
She reported fatigue related to work.
I had a dog at home.
She had not traveled recently and had no known contact with tuberculosis patients.
Physical examination showed good general condition, eupneic with a basal oxygen saturation of 98%.
He had no lymphadenopathy or acropachia.
Cardiopulmonary auscultation was normal.
Chest X-ray showed a diffuse linear interstitial pattern with right predominance.
The study was completed with several complementary examinations: blood analysis with all parameters within the normal range, including autoimmunity and negative serology, lung function tests (LFTs widely distributed with lung cavitation) showing both upper lung fields.
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With these findings bronchoscopy was performed without evidence of mucosal alterations or lesions.
Three LAB were performed in the right upper lobe, which were diagnosed for cytological, bacilloscopy and lymphocyte subpopulations.
In addition, four bronchoaspirates of secretions (BAS) were performed for cystic fibrosis, culture and Koch bacillus.
All results were negative.
The anatomopathological report of the bronchoaspirate revealed a minimal inflammatory component, with no anomalous histiocytes or interstitial cells.
Immunohistochemistry was negative for S100 and CD1a.
Given the result, a biopsy of the right upper lobe of the lung was performed.
Histopathology was compatible with Langerhans' histiocytosis in proliferative phase or cell phase.
The patient was recommended to stop smoking.
The patient was reviewed 3 months later and reported being asymptomatic with a gain of 6 kg. However, the chest X-ray showed interstitial pattern control.
