The woman, 55 years old, is a housewife and a former smoker of 1 pack/years. She underwent a hysterectomy for uterine fibromatosis, and a surgical operation for right humerus osteochondroma. She has got a herpes simplex virus type I infection. At the time of our first observation she referred in the last 2 years dry cough with little sputum, dyspnea grade II according to the American Thoracic Society (ATS) scale and mild fever. At the beginning of the symptoms she performed a chest x-ray which showed "interstitial thickening" and a microbiological sputum examination which was negative for tuberculosis and fungal infection. The general practitioner gave her a non-specific antibiotic therapy with low benefit and then a steroid therapy with improvement in symptoms. At the time of our observation, she underwent a total-body CT scan which showed "a series of lung nodules distributed in all lobes; a solid slab in the mantle of the apical segment of the left lower lobe; several small adenomegalies in the anterior mediastinum, around the trachea and below aorta artery; no evidence of effusion in the pleural cavity" in the thorax (Figure 1). The CT scan showed the "presence of enlarged lymph nodes in the following areas: celiac/pancreatic lombo-aortical, bilateral internal iliac, bilateral obturator, bilateral external iliac and bilateral inguinal" in the abdomen. 
The 6-min walking test was normal and the pulmonary function tests showed a reduction in the diffusing capacity for carbon monoxide (DLCO) (Table 1). The arterial blood gas analysis performed during spontaneous breathing at FiO2 of 0.21 showed mild hypoxemia at rest with minimal alterations of intrapulmonary gas exchange, and normal acid-base balance: PaO2: 73 mmHg; PaCO2: 37,9 mmHg; pH: 7,41. The serum level of angiotensin I-converting enzyme (ACE) was normal.