A 42-year-old man presented with the compliant of cough and breathlessness (modified medical research council grade-II) for the last 5 years with mild non-documented fever (on and off) for last 6 months. There is no significant past history. He was on antitubercular therapy (ATT) for last 3 months on basis of clinic-radiological diagnosis with no improvement in symptoms. He is a scissor/knife sharper by occupation with exposure for iron dust for the last 25 years. He is a non-smoker. On examination, general physical examination was normal. On respiratory examination, there was bilateral vesicular breath sound with bilateral fine crepitation. Routine haematological and biochemical investigation were normal. X ray of chest (postero-anterior view) showed bilateral nodular opacities in all zones [Figure 1]. Sputum for acid fast bacilli (AFB) direct smear was twice negative. Connective tissue serological profile (ANA, Rheumatoid factor, p-ANCA/c-ANCA, Scl-70) was negative. Serum angiotensin converting enzyme level was 118 U/l. His 6-min walk test (6MWT) was 320 m with desaturation of 9%. Pulmonary function test (PFT) showed FVC-2.63lts (73%), FEV1-1.31lts (44%), FEV1/FVC-50, TLC-5.06 (99%) and DLCO-23.56 (88%). HRCT chest showed numerous reticulonodular densities in bilateral lung fields and multiple nodular lesions in the sub-pleural aspect of the right lower lobe with fibrolinear densities in both upper lobes [Figure 2a-d]. Bronchoscopy showed normal bronchial tree. Bronchoaveolar lavage (BAL) and Transbronchial lung biopsy (TBLB) were obtained from the right middle lobe. The AFB smear and geneXpert of BAL fluid were negative. The bacterial and fungal cultures from the BAL fluid were sterile. TBLB showed heavy deposition of dark to brown pigment in perivascular and peribrochiolar areas with mild chronic inflammation and focal interstitial fibrosis. Iron stain shows fine and coarse granules in macrophages on prussian blue. [Figure 3a and b] He was finally diagnosed as pulmonary siderosis, ATT was stop and advised to change occupation and use of protective gear while working.