Pulmonary Langerhans Cell Histiocytosis (PLCH) is an uncommon interstitial lung disease seen in smokers; it can often be misdiagnosed as other pulmonary disease. Here we describe a 27 year old male smoker who presented to us with history of fever, cough and breathlessness of 3 months duration. Patient was diagnosed as sputum negative pulmonary tuberculosis and he was put on antitubercular therapy 15 days prior hospitilazation. Patient developed bilateral pneumothorax on day 2 of admission. Subsequent further evaluation with x-ray chest showed bilateral diffuse reticulocystic changes and pneumothorax. HRCT chest showed bilateral pneumothorax, bilateral nodular thin walled cysts of varying size in upper lobes classically suggestive of PLCH. Patient underwent intercostal tube insertion and the pneumothorax resolved in 15 days. Later on pleurodesis with tetracycline was done; patient was discharged with advice of abstinence from smoking and supportive medication.
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