Physical examination revealed a well-developed, well-nourished white man in no respiratory distress. Vital signs were normal, and respiratory rate was 12 breaths/min and unlabored. No evidence of uveitis, cervical or supraclavicular adenopathy, or adventitious breath sounds were found on physical examination. There was no enlargement of the liver, kidney, or spleen, and peripheral pulses were normal. Clubbing, cyanosis, and edema were absent, and there were no significant rashes. Pulmonary function studies revealed a vital capacity of 5.3 L (103% of predicted), with an FEV1 of 4.3 L (108% of predicted). Total lung capacity measured 6.8 L (94% of predicted), and diffusion capacity of the lung for carbon monoxide measured 32.3 mL/min/mm Hg (100% of predicted). Radiographs of the chest dating October 16, 2001, were compared to radiographs obtained in June 2000. Diffuse bilateral reticular nodular infiltrates were seen without zonal predominance, hilar adenopathy, or pleural effusion. There was no evidence of pleural thickening or bony abnormalities. Prior radiographic findings were entirely normal. CT examination of the chest (Fig 1
) confirmed the presence of innumerable tiny, discrete densities, widely distributed bilaterally, each measuring < 1 cm in diameter. No evidence of pleural fluid, hilar or mediastinal adenopathy, or cardiac enlargement was noted. Urinalysis results were unremarkable. Hemoglobin measured 15.1 g/dL, and WBC count was 5,900/mL with normal distribution. Total eosinophil count measured 2.6%, and erythrocyte sedimentation rate was 1 mm/h. Antinuclear antibody findings were negative. HIV testing was nonreactive, and the angiotensin-converting enzyme level was 76.9 U/L. Protein serum electrophoresis was normal. Total protein was 7.6 g/dL, alkaline phosphatase was 101 U/L, aspartate transaminase was 24 U/L, creatinine was 1.0 mg/dL, and glucose was 73 mg/dL.