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Acute exacerbation of IPF — SCE Respiratory MCQ

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HardInterstitial lung diseaseAcute exacerbation of IPFSCE Respiratory

A 74-year-old man with known IPF deteriorates over 10 days with new hypoxaemia. CT pulmonary angiography excludes embolism but shows new bilateral ground-glass opacities superimposed on established UIP. CRP is 24 mg/L, sputum cultures are negative and echocardiography does not suggest heart failure. He requires 60% oxygen to maintain SpO2 91%. What is the most likely diagnosis?

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Correct answer: A — Acute exacerbation of IPF

Rapid respiratory decline with new diffuse ground-glass change on UIP and exclusion of alternative causes supports acute exacerbation of IPF. Stable progression is slower and does not usually create abrupt new bilateral infiltrates. Prognosis is poor, so management should include supportive care, infection exclusion, senior discussion and early ceiling-of-care planning.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/respiratory-conditions