Abstract
A 77-year-old male presented with progressive shortness of breath (SOB) over three weeks. Initial chest x-ray (CXR) and computed tomography (CT) scan of the chest showed bilateral extensive airspace opacities and dense perihilar consolidation. Over the subsequent 48 hours, the patient suffered hypoxemic respiratory failure requiring transfer to the intensive care unit (ICU) for mechanical ventilation (MV) support. Bronchoscopy and Broncho-alveolar lavage (BAL) was done on the third day of admission and samples were negative for bacterial and fungal culture but confirmed the presence of influenza A virus using rRT-PCR method. Oseltamivir was started and continued for 10 days. Due to lack of improvement of hypoxemia and worsening air space opacities on CXR, open lung biopsy (OLB) was performed and demonstrated histopathology consistent with cellular non-specific interstitial pneumonitis (NSIP). Prednisone was started for NSIP. The patient was successfully liberated from MV and was eventually discharged home breathing on room air.