60-Year-Old Man with Cough, Fever, and Shortness of Breath Diagnosed with Idiopathic Pulmonary Fibrosis
In this case study, we explore the journey of a 60-year-old male patient who presented with persistent respiratory symptoms that were eventually diagnosed as idiopathic pulmonary fibrosis (IPF), a chronic and progressive lung disease. The information has been anonymized for privacy and is shared solely for educational and awareness purposes.
Overview: From Chronic Cough to IPF Diagnosis
A man in his sixties came to our emergency department after experiencing worsening shortness of breath, fever, and productive cough for six days—symptoms that had significantly deteriorated following a recent cold. He had been dealing with intermittent dry cough for over two years without seeking comprehensive medical evaluation. Initially dismissed as minor respiratory issues, his condition gradually progressed, culminating in acute exacerbation requiring hospitalization. Imaging and clinical assessments at our center led to a definitive diagnosis of idiopathic pulmonary fibrosis, a serious interstitial lung disease often mistaken for recurrent infections or other less severe conditions.
Patient Profile & Clinical Timeline
Age/Sex: 60-year-old maleDiagnosis: Idiopathic Pulmonary Fibrosis (IPF)Hospital: Second Affiliated Hospital of Harbin Medical UniversityDate of Admission: December 2021Treatment Plan: Pharmacological therapy including prednisone acetate, amoxicillin capsules, and pirfenidone tabletsTreatment Duration: 10-day inpatient care followed by 3 months of outpatient follow-upOutcome: Significant symptom relief and improved radiological findings
Initial Evaluation: Uncovering a Hidden Lung Disease
The patient first noticed occasional dry coughing two years prior, with no associated fever, chest pain, weight loss, joint discomfort, skin rashes, or signs of autoimmune disorders. A CT scan performed in March 2020 revealed early signs of interstitial changes—specifically, thickening of the pulmonary lobular septa forming a reticular pattern—but he did not pursue treatment at the time. By September 2021, after catching a cold, he developed nasal congestion, clear rhinorrhea, and began coughing up white sputum. Though upper respiratory symptoms improved with over-the-counter remedies, the cough persisted and was now accompanied by exertional dyspnea—becoming noticeable after walking just 100 meters or climbing three flights of stairs.
A follow-up CT scan showed diffuse reticular opacities and ground-glass infiltrates predominantly in the subpleural regions of both lungs, raising suspicion for idiopathic pulmonary fibrosis. Despite medical advice to start corticosteroid therapy, the patient declined due to concerns about side effects. Over the next few months, his exercise tolerance continued to decline. Six days before admission, another respiratory infection triggered a sharp deterioration: he began producing large amounts of yellow, viscous phlegm, developed a fever, and experienced progressively worsening breathlessness during routine activities. With no relief from self-medication, he sought emergency care at our hospital, where he was admitted for further investigation and management.
Diagnostic Workup and Therapeutic Strategy
Given the progressive nature of his symptoms and worsening imaging results, a thorough diagnostic approach was essential to rule out secondary causes and confirm IPF. During hospitalization, the following steps were taken:
1. Bronchoscopy with Microbiological Sampling
To exclude infectious triggers such as bacterial, fungal, or mycobacterial pneumonia, bronchoalveolar lavage (BAL) fluid was collected. After three days, cultures returned negative for pathogens, supporting the absence of active infection.
2. BAL Fluid Analysis
Cellular analysis of the lavage fluid showed elevated levels of neutrophils and lymphocytes but no malignant cells, consistent with non-infectious inflammation seen in interstitial lung diseases like IPF.
3. Autoimmune Screening
Blood tests for antinuclear antibodies (ANA) and ANCA (anti-neutrophil cytoplasmic antibodies) came back negative. Additionally, the patient lacked clinical features of connective tissue diseases—such as joint pain, photosensitivity, dry eyes/mouth, or dermatomyositis-like skin changes—making autoimmune-related interstitial pneumonia unlikely.
4. Radiological Confirmation
Chest HRCT demonstrated classic hallmarks of usual interstitial pneumonia (UIP) pattern: subpleural and basal-predominant reticulation, honeycombing, and traction bronchiectasis. These findings, combined with exclusion of alternative diagnoses, supported a final diagnosis of idiopathic pulmonary fibrosis.
Based on this assessment, treatment was initiated with oral prednisone acetate to reduce inflammatory activity. Because of the recent infection and purulent sputum production, amoxicillin was added to prevent secondary bacterial complications. Upon discharge, the patient was prescribed pirfenidone—a disease-modifying agent proven to slow fibrotic progression—and advised to taper off steroids gradually under supervision.
Treatment Response and Recovery Progress
Within days of starting therapy, the patient reported marked improvement in breathing, reduction in fever, and decreased cough frequency. After 10 days of in-hospital care, a repeat CT scan showed partial resolution of infiltrative patterns, confirming therapeutic efficacy. He was discharged with stable vital signs and a clear recovery trajectory.
As IPF is a long-term condition with no cure, ongoing maintenance therapy with pirfenidone was emphasized. Patients must understand that while symptoms can be managed and progression slowed, regular monitoring is crucial. Follow-up appointments scheduled every three months included pulmonary function tests (PFTs) and periodic high-resolution CT scans to track disease status and medication tolerance.
Key Recommendations for Long-Term Management
While the immediate crisis was resolved, sustainable health outcomes depend on consistent post-discharge care. Here are critical guidelines for patients living with IPF:
1. Medication Adherence and Monitoring
Strict compliance with prescribed medications—including immunosuppressants and antifibrotic agents—is vital. Never discontinue or adjust dosages without consulting your physician. Regular check-ups allow doctors to assess response to treatment and manage potential side effects such as gastrointestinal upset or liver enzyme elevations linked to pirfenidone.
2. Lifestyle Adjustments for Better Lung Health
Diet plays an important role in overall wellness. Focus on balanced nutrition rich in antioxidants, lean proteins, and whole grains. Avoid spicy, greasy, or overly processed foods that may trigger inflammation. Stay well-hydrated to help loosen mucus secretions.
3. Avoid Lung Irritants and Embrace Healthy Habits
Smoking cessation is non-negotiable—even former smokers must remain smoke-free. Exposure to environmental pollutants, dust, and chemical fumes should also be minimized. Moderate physical activity, such as walking or pulmonary rehabilitation exercises, helps maintain lung capacity and improves quality of life. Any new or worsening symptoms—like increased breathlessness, unexplained fatigue, or bloody sputum—should prompt immediate medical consultation.
Clinical Insights: Why Early Diagnosis Matters
Idiopathic pulmonary fibrosis remains a challenging diagnosis due to its insidious onset and similarity to more common respiratory illnesses. Many patients initially attribute their symptoms to aging, smoking, or recurrent bronchitis. This case highlights several key learning points:
- Misconceptions about steroid use: Some patients resist corticosteroid therapy due to fears of side effects. However, in selected cases—especially during acute flares—short-term steroid use can be beneficial when combined with targeted antifibrotics.
- Differential diagnosis is essential: UIP-like patterns can arise from various causes, including occupational exposures (e.g., asbestos, silica, bird antigens) or undiagnosed connective tissue diseases. Comprehensive serologic testing and exposure history are critical.
- Prognosis improves with timely intervention: While IPF carries a poor long-term outlook, early detection and modern therapies like pirfenidone and nintedanib have been shown to extend survival and preserve lung function.
This patient's outcome underscores the importance of recognizing subtle warning signs and seeking specialized care promptly. With proper diagnosis, individualized treatment, and dedicated follow-up, individuals with IPF can achieve meaningful symptom control and maintain a better standard of living.