Case 73

 A seventy three-year-old male presented for dyspnea. He has been suffering dyspnea at working for approximately one month. He felt dyspnea after going up slope since the previous year but recently, he felt dyspnea even after walking a flatter street. Thereafter, dyspnea worsened that he felt dyspnea even after taking a bath or a washroom. He stopped smoking 15 years ago and he had no pet. He was diagnosed collagen disease twenty years ago. He had experienced skin rash and migrating arthritis in the past. He had clubbed fingers. Peripheral PO₂: 50.2 mmHg. Laboratory test revealed CRP 1.36 mg/L, KL-6 3500 U/L (<500), SP (surfactant protein)-D 219 ng/mL (<110), SP-A 74.7 ng/mL (<43.8) Anti-double stranded DNA immunoglobulin G 293 IU/mL (<10), negative RA factor. He received chest CT for further investigation (Figs. 1, 2).

What is the appropriate diagnosis based on chest CT and laboratory data ?

1. Idiopathic pulmonary fibrosis/ Usual interstitial pneumonia

2. Lymphocyte interstitial pneumonia

3. MPO-ANKA associated interstitial pneumonia

4. Collagen vascular disease associated interstitial pneumonia

5. Chronic hypersensitivity pneumonia

answer

2017.9.27