Pulmonary Langerhans Cells Histiocytosis (Clinical Case)
Authors: Lutsyshyn K.O. , Zhemela A.I. , Hryshchuk L.A. , Hospodarskyy I.Ya. , Boyko T.V. , Slyzka O.M. , Bilyk S.O. , Vynnychuk M.O. 
Published: February 2025

We describe a clinical case of pulmonary histiocytosis from Langerhans cells. Patient P. is 57 years old, lives in a village. The disease began in October 2022 with complaints of morning cough, shortness of breath during physical activity. Complaints persisted for about 6 months and increased in dynamics. Over the past 3 months, he has lost 3 kg. He sought medical care from his family doctor, where on 07.04.2023 a computed tomography scan of the chest was performed and severe pathological changes in the lungs were detected. The patient was referred to a pulmonologist for consultation, and after further examination was hospitalized in the pulmonology department of the Ternopil Regional Phthisiopulmonology Medical Center. His medical history revealed that he had been in contact with pigeons for about 50 years. He was engaged in repair work and did not use respiratory protection. Additional examination methods were performed. Computed tomography of the chest cavity dated 07.04.2023, conclusion — diffuse interstitial changes in the lung parenchyma. Bilateral multisegmental pulmonary nodules and thin-walled pulmonary cysts. Bronchoscopy and pathological examination were performed. The patient was consulted by a cardiologist. The clinical diagnosis was «Pulmonary Langerhans cell histiocytosis, active phase, first detected. «Honeycomb lungs». Bilateral diffuse pneumofibrosis. Chronic pulmonary heart disease. Metabolic cardiomyopathy. Transient extrasystole. Heart failure, stage I. Incomplete blockade of the right leg of the bundle of his». Treatment was prescribed according to the clinical guidelines. On 12.05.2023 he was discharged for outpatient treatment with improvement of his general condition.In December 2023, the patient completed the course of treatment and began to notice an increase in shortness of breath with minimal physical activity, dry cough, and therefore on January 16, 2024, the patient consulted a pulmonologist, where, after further examination, he was hospitalized in the pulmonology department. After the examination the patient was diagnosed with: Chronic Obstructive Pulmonary Disease (COPD) stage II, group E, fase of infectious exacerbation. Pulmonary Langerhans cell histiocytosis, sluggishly progressive course, active phase. «Honeycomb lungs». Bilateral diffuse pneumofibrosis, coronary artery disease. Cardiosclerosis. Aortosclerosis. Incomplete blockade of the right pedicle of the bundle of His. Chronic pulmonary heart disease. Heart failure, stage I, functional class I.It has been established that pulmonary Langerhans cell histiocytosis is a systemic pathology that in most cases leads to chronicity of the process, damage to the bronchopulmonary system (in this case, the onset of COPD); cardiovascular system (development of coronary heart disease), which requires constant pharmacological treatment and medical monitoring. In the case of a typical CT picture (widespread cystic lung disease with cysts of varying sizes and shapes with relative sparing of the lung bases and small solid nodules), a patient should be guided by a general practitioner (family doctor) to the pulmonologist to confirm or exclude pulmonary Langerhans cell histiocytosis. This allows for early diagnosis and treatment.