How Real is the Diagnosis of Copd in a Young Patient?

We present the case of a young patient, known to have COPD and DZ, who presented to the emergency room for dyspnea and sudden onset right laterobasal pain. From the patient's recent history we note episode of right total pneumothorax five days prior to presentation to our unit, for which pleural drainage was fitted. Clinical examination and standard chest X-ray performed in the emergency department established the diagnosis of recurrent total pneumothorax. Given the medical history and recent history of pneumothorax in a young heavy smoker patient with two episodes of right pneumothorax, one of which was recent, known with diabetes mellitus and COPD, with imaging changes such as "reticulo-nodular lesions with cystic appearance and interstitial fibrosis on the left lung area", the diagnosis of COPD was questioned and the suspicion of pulmonary histiocytosis X was raised, which is why, together with the radiologist and thoracic surgeon, the decision was made to perform a surgical treatment and a lung biopsy to establish a definite diagnosis. The result of the lung biopsy confirmed the suspicion of pulmonary histiocytosis X.

Since in histiocytosis X the damage is multi-organ, one month postoperatively the patient underwent a complex biological, functional and imaging evaluation to identify or exclude other affected organs. Imaging and functional investigations performed, collaborated with the patient's history, age and medical history refuted the diagnosis of COPD. Therapeutically for pulmonary histiocytosis X it was recommended to stop smoking urgently and monitor respiratory function at 6 months in the first year after diagnosis.