Case

A 47-year-old male presented with chronic cough, which has worsened over the last 5–6 months. Dyspnoea, fever and significant weight loss were denied. The patient had no history of smoking or vaping. The patient worked as an automotive technician in a car manufacturing plant specialised in aluminium-based vehicle bodies with frequent exposure to metallic fumes during polishing and welding of aluminium/beryllium alloy for more than 26 years. There was no history of asbestos exposure.

Respiratory examination was normal with no skin lesions or palpable lymphadenopathy. CT chest revealed mediastinal and hilar lymphadenopathy along with diffuse parenchymal opacities, including irregular nodular shadows and bilateral lung masses with irregular borders in both lower lobes (figure 1). The radiological findings raised suspicion for a metastatic disorder. Other possible differential diagnosis includes healed or non-specific granulomas, active granulomatous infection such …