A 58-year-old man with IPF (usual interstitial pneumonia on HRCT) shows acute worsening with bilateral ground-glass opacities superimposed on his fibrotic background over 30 days. No infection or heart failure identified. What is this condition, and what is the treatment?
- A Community-acquired pneumonia; broad-spectrum antibiotics
- B Acute exacerbation of IPF; high-dose corticosteroids (though evidence limited) ✓
- C Ventilator-associated pneumonia; meropenem
- D Drug reaction to nintedanib; drug withdrawal
Correct answer: B. Acute exacerbation of IPF; high-dose corticosteroids (though evidence limited)
Explanation
Acute exacerbation of IPF (AE-IPF) is defined as acute, clinically significant deterioration with new bilateral ground-glass opacities superimposed on UIP pattern within 30 days, after excluding infection, heart failure, and other causes. It carries very high mortality (>50%). Treatment with high-dose corticosteroids is standard despite poor evidence; methylprednisolone 0.5–1 g/day IV for 3 days is commonly used. Nintedanib and pirfenidone slow progression of stable IPF but do not treat acute exacerbations.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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