Pulmonary dissemination syndrome is a radiological syndrome characterised by the development of multiple focal opacities and/or an increase and reticular deformation of the lung pattern, often bilaterally. It can occur in the development of various pathological processes, with over 200 different lung diseases associated with its development.Key components of differential diagnosis include a thorough study of the patient’s history, evaluation of clinical symptoms, radiological imaging and the dynamics of the process during observation, laboratory indicators and spirometry data. If a diagnosis cannot be established, it is appropriate to perform transbronchial lung biopsy or video thoracoscopy with biopsy of the most affected lung areas.This paper presents current data on the development of a rare variant of disseminated granulomatous process in the lungs, which can occur in drug-dependent individuals who intravenously inject solutions or suspensions of drugs originally manufactured in tablet form and intended for oral use. Literary data and personal observations from practice are provided. Typically, such patients do not have specific complaints or clinical signs, and their laboratory indicators are also non-specific. Radiologically, a disseminated process in the lungs is diagnosed. The main diagnostic measure in such cases is surgical lung biopsy followed by morphological examination. Histological descriptions of peculiar changes in lung tissue and useful additional studies for differential diagnosis are presented. Two cases are detailed, one of which involved a combination of morphological signs of past tuberculosis with manifestations of another giant cell granulomatous process.It is crucial in the diagnosis of this pulmonary pathology to establish and clarify the history—repeated intravenous administration of drugs intended for oral use, as most patients tend to conceal this information.