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Acute exacerbation of fibrotic interstitial lung disease — SCE Acute Medicine MCQ

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ModerateRespiratory medicineAcute exacerbation of fibrotic interstitial lung diseaseSCE Acute Medicine

A 67-year-old woman with known fibrotic interstitial lung disease presents with 5 days of worsening breathlessness. Oxygen saturation is 84% on air, CRP is 48 mg/L and chest radiograph shows new bilateral patchy shadowing. CT pulmonary angiography excludes pulmonary embolism and shows new diffuse ground-glass change superimposed on fibrosis. Blood cultures are pending and she is not fluid overloaded. What is the most likely diagnosis?

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Correct answer: E — Acute exacerbation of fibrotic interstitial lung disease

New bilateral ground-glass change on a fibrotic background after excluding pulmonary embolism and overt cardiac failure is typical of acute exacerbation of fibrotic ILD, though infection must be actively sought and treated empirically when appropriate. Lobar pneumonia would usually produce more focal consolidation, and pulmonary oedema would be supported by fluid overload or cardiac features. The pearl is that acute ILD exacerbations are diagnoses of exclusion but should be recognised early because they carry high mortality.

Reference: BTS guideline for interstitial lung disease; NICE CKS pulmonary fibrosis