INTRODUCTION: Pulmonary Langerhans Cell Histiocytosis (PLCH), a rare and uncommon interstitial lung disease, is often misdiagnosed due to a confluence of non-specific symptoms and lack of diagnostic testing. Here we present the case of a patient who fell outside the typical demographic and symptom profile and experienced a protracted treatment course as a result. CASE PRESENTATION: A 69 year old woman with a medical history of chronic hepatitis-C was admitted for cough and fever. CT Chest revealed numerous diffuse bilateral ground-glass and nodular opacities. Echocardiogram demonstrated an echogenic density in the mitral valve which was suspicious for vegetation. She was discharged with a 4 week course of ceftriaxone for presumptive cavitary pneumonia secondary to endocarditis and readmitted after a month for persistent cough and fever. Repeat CT Chest was unchanged and echocardiogram showed no clear evidence of vegetations. Bronchoscopy with bronchoalveolar lavage was performed; cytology and culture were negative for malignancy and pathogens. She underwent video-assisted thoracoscopic wedge resection and pathology demonstrated features consistent with multifocal Langerhans cell histiocytosis. Antibiotics were discontinued and the patient was started on a 6 month prednisone taper with complete resolution of symptoms.
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