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Acute exacerbation of idiopathic pulmonary fibrosis — SCE Acute Medicine MCQ

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HardRespiratory medicineAcute exacerbation of idiopathic pulmonary fibrosisSCE Acute Medicine

A 64-year-old man with idiopathic pulmonary fibrosis presents with three days of rapidly worsening breathlessness. CT pulmonary angiography shows no PE but new bilateral ground-glass change superimposed on usual interstitial pneumonia. CRP is 38 mg/L and sputum culture is pending. He is hypoxic despite 60% oxygen. What is the most likely diagnosis?

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Correct answer: D — Acute exacerbation of idiopathic pulmonary fibrosis

Acute respiratory deterioration with new bilateral ground-glass opacities on a UIP background and exclusion of PE supports acute exacerbation of IPF. Infection can mimic or precipitate it, so cultures and pragmatic antimicrobials may be considered, but the imaging pattern is not simple lobar pneumonia. The prognosis is poor and early respiratory/critical care and ceilings-of-care discussion are important.

Reference: BTS Interstitial Lung Disease Guideline; NICE CKS Pulmonary fibrosis