Occupational lung diseases caused by metal oxide are classified as follows, metal fume fever, chemical pneumonitis, hypersensitivity pneumonitis, and occupational asthma. Even though it's well known the immunologic mechanism is involved in metal fume fever, the exact cause is unkown yet. Some authors have speculated that metal fume fever is a form of hypersensitivity pneumonitis. A smelter exposed to metal oxide fumes was hospitalized with some complaints such as severe cough, dyspnea and fever. Chest radiographs on admission showed ill-defined reticulonodular density especially prominent in the base of the both lower lobe. HRCT of chest was observed diffuse fine granolar and reticular involvement with multiple small honeycomb cystic lesion. Bronchoalveolar lavage showed a lymphocyte predominant alveolitis and TBLB had the finding of noncaseating granuloma infiltrating with giant cells, lymphocytes and macrophages. This is a case of alveolitis caused by metal oxide fume which has the characteristics of hypersensitivity pneumonitis in clinical picture and the finding of BAL and TBLB.