BACKGROUND Pulmonary alveolar microlithiasis (PAM) is an uncommon pulmonary disease characterized by deposition of microliths in the alveoli. In this report, we describe the first ever documented case from the Indonesian population of an adult patient who was diagnosed with PAM based on clinical and pathognomonic radiological findings. CASE REPORT A 57-year-old man with a 12-year history of progressive shortness of breath on exertion was admitted to our center. When the lungs were listened to, there were coarse crackles and wheezing during inspiration, and the vesicular sound was lower in all thoracic regions. Cardiac auscultation was unremarkable, with fingers having a clubbed drumstick appearance. Bronchoscopy revealed all patent branches of the bronchial tree. Unfortunately, the microliths were absent, and the histology findings from bronchoalveolar lavage and transbronchial lung biopsy were inconclusive. Radiologic features of a chest radiograph show the characteristic finding of multiple diffuse micronodules with a high density in both lungs. A high-resolution computed tomography (HRCT) scan corroborated the typical findings of extensive intraparenchymal calcified micronodules with diffuse ground-glass attenuation areas. Black pleural line signs were also seen. CONCLUSIONS PAM is a rare disease with a chronic clinical course and varying manifestations according to phase, but progressive deterioration may result in a poor prognosis. It is particularly important for clinicians to be able to narrow down the differential diagnosis of multiple diffuse micronodules of the lungs. When a non-invasive method of diagnosis is preferred, chest X-rays and, even better, HRCT should be used to find the characteristic features of alveolar microlithiasis.