An unusual case of chronic airflow obstruction in a heavy smoker

We report here the case of a 49-year-old perimenopausal woman, current smoker of 30 pack-years, that was referred to our attention in our outpatient pulmonology clinic for the presence of progressive exertional dyspnea and persistent cough. In the last five years the patient has been seen in many different pulmonology outpatient clinics for the presence of chronic airflow obstruction and performed four computed tomography of the chest that showed the presence of a diffuse and bilateral cystic pattern in the lung parenchyma. After a careful differential diagnostic approach including medical history, lung function tests, laboratory exams and chest imaging reanalysis a diagnosis of pulmonary Langerhans Cell Histiocytosis was made with therapeutic recommendation of cigarette smoking cessation. Chronic airflow obstruction and diffuse and bilateral cystic lung disease have many different causes. A complex differential diagnosis must be applied to every patient to understand the etiology and to provide the specific treatment.