The differential diagnosis of granulomatous lung diseases presenting with multiple nodules remains clinically challenging. Sarcoidosis, hypersensitivity pneumonitis, pneumoconiosis, and tuberculosis are the primary considerations.We present the case of a 39-year-old male with progressive dyspnea and a five-year history of untreated sarcoidosis, initially diagnosed based on thoracic computed tomography (CT) findings of bilateral pulmonary nodules and hilar lymphadenopathy. After being lost to follow-up, the patient returned with evidence of clinical and radiological progression. A bronchial mucosa biopsy revealed noncaseating granulomatous inflammation.Despite corticosteroid therapy for presumed sarcoidosis progression, followed by empirical antitubercular treatment for smear- and culture-negative tuberculosis, the patient showed no clinical improvement. A detailed occupational history revealed a ten-year background of working as a dental technician, ultimately leading to the diagnosis of the rare condition known as dental technician’s pneumoconiosis.This case highlights the critical importance of evaluating occupational exposures in the differential diagnosis of granulomatous lung diseases, particularly in scenarios where clinical, radiological, and pathological findings overlap.
Ergün et al. (Mon,) studied this question.