An 81-year-old man with idiopathic pulmonary fibrosis (IPF) came to our hospital with symptoms of fever and worsening dyspnea. We diagnosed an acute exacerbation of IPF (AE-IPF) on the basis of the findings of high-resolution computed tomography of the chest and thus started steroid therapy. However, we detected
Mycobacterium tuberculosis in the sputum and concluded that pulmonary tuberculosis coexisted with AE-IPF. Because high-resolution computed tomography showed circumscribed consolidation in S
10 of the left lung, we suspected that the consolidation was the focus of the tuberculosis. We started treatment of the pulmonary tuberculosis with antituberculous drugs; however, we were unable to control the AE-IPF, and the patient died. Interpreting the imaging findings of infection is difficult, particularly in cases of AE-IPF, which is associated with consolidation and may coexist with infection. The frequency of tuberculosis was higher in patients with IPF than in the general population. In cases of AE-IPF caused by infection, screening sputum tests, including those for acid-fast bacteria, are useful.
View full abstract