Interstitial Lung Disease

Old pulm koch + ILD(UIP on CT Thorax) Chief Complaints A 58 yr old male has come with Right sided chest pain and non productive cough since 15 days. Had similar history in past which gets aggravated during winters. No associated SOB, fever, pedal edema allergic rhinitis. No past H/O HTN/DM/Thyroid disorder/substance abuse/COPD or taking any bronchodilator. Past H/O pulm koch for which pt had taken ATT 20 yrs back. Normal vesicular sounds on auscultation , No added sounds. CXR, covid RAT and RT PCR and other routine Ix were done . All were neg and normal except mild fibrotic, reticular opacities and bronchiectatic changes in B/L lung on CXR. PFT showing restrictive pattern. Pt was advised CT thorax. CT thorax is showing similar UIP features with honeycombing, fibrosis suggestive of ILD. We are now planning to start anti fibrotic therapy and other symptomatic treatment.

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Post tubercular bronchiectasis. Evaluate and treat for active infection. Inhaled bronchodilators Influenza and pneumococcal vaccination. Antifibrotics if progressive fibrosis.

Good presentation and proper work up. I think antifibrotics with small dose of steroid are good. Can also think of us if Pirfinadone or similar agent ...

Possibly a case of *post tuberculous sequelae-B/L fibrobronchiectasis *Treat him with inhaled bronchodilators, Mulcolytics,chest physiotherapy. *Do sputum evaluation(AFB, C/S) /echo *Plan for a repeat CT after 6 months to reaccess the progression of fibrosis.(if there s a worsening, start antifibrotic therapy)

Nintedanib would be a better option

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