A 27 years old man with dyspnea

• CC: Dyspnea (ATS G IV)• PI: previous healthy,

– Mild dyspnea, fatigue, general weakness, cough, 2 weeks ago, recently aggrevated.

• FHx: His mother died (leukemia, 26 years ago), TB(+)

• Smoking(+), Alcohol(+)• Occupathion Hx: PC 방 , 호프집 아르바이트 ,

미용재료 납품 , 최근 영업직으로 전환 .

Multiple small rounded nodules scattered through both lungs.

Multiple small rounded nodules with ground-glass opacities

Transbronchial lung biopsy: Multiple small granulomas

Transbronchial lung biopsy: Multiple small granulomas

Transbronchial lung biopsy: A granuloma with central caseating necrosis (arrow)

AFB stain