A 63-year-old woman presented with a short history (a few months) of persistent cough and mild shortness of breath. On further enquiry, she admitted to having a poor appetite, with an associated weight loss of approximately 4 kg over a period of 6 months. Clinical examination was unremarkable and did not reveal any signs of lung malignancy. A chest roentgenogram showed bilateral multiple pulmonary nodules (Fig 1
). Blood tests for angiotensin-converting enzyme levels, systemic vasculitic screen, antineutrophil cytoplasmic antibody, and rheumatoid factor were normal. The C-reactive protein was mildly elevated at 52 mg/L.