The case refers to a 58-year-old man, with a medical history of hyperthyroidism and cannabis consumption of approximately 25 years. He presented a clinical picture of about two years of evolution with respiratory symptomatology, characterized by episodes of cough and dyspnea, in addition to symptoms of thyroid decompensation. The patient's symptoms were exacerbated in the two months prior to his initial consultation, accompanied by weight loss and unquantified febrile episodes. The patient has a 25-year work history of marble handling. Treatment. Interventions focused on making a comprehensive diagnosis. A bronchoscopy with bronchoalveolar lavage was performed which reported the presence of Mycobacterium tuberculosis and a transbronchial biopsy was taken which identified “pulmonary parenchyma with nodules consisting of hyalinized collagen bundles and surrounded by macrophages with brown pigments: in addition, he presented bronchial mucosa with chronic inflammation”. Strictly supervised shortened treatment with antipyretics, an oral adrenergic beta-blocker, thionamides and counseling for addiction control and cessation of marble exposure was provided. Outcome. Respiratory and metabolic clinical improvement was evidenced. Follow-up with telemedicine was provided one month after medical discharge.

William Laínez completed his doctoral studies in medicine at the age of 25 and subsequently began postgraduate studies in internal medicine. He is currently in his third year of the specialty, focusing on ultrasound applications in emergency departments, with a focus on cardiology and pulmonary medicine. He holds a diploma in clinical ultrasound, has participated in conferences as a speaker in Peru, and has published a case report in the field of pulmonology in the indexed journal ALERTA. Case reports of atypical acute coronary syndromes are currently pending publication.