In 2008, Kawabata et al. described a lesion which they termed "airspace enlargement with
fibrosis" that could be included on the spectrum of smoking-related
interstitial lung diseases. This group also reported that patients with airspace enlargement with
fibrosis but without coexisting
interstitial pneumonia of another type had no acute exacerbations and favorable prognoses on clinical follow-up. Here we describe the first case, to our knowledge, of acute exacerbation of airspace enlargement with
fibrosis without coexisting
interstitial pneumonia of another type. An 82-year-old man was referred to our department for worsening
dyspnea and new alveolar opacities on chest radiograph following left pulmonary
segmentectomy (S6) for
cancer. A diagnosis of acute exacerbation of airspace enlargement with
fibrosis without coexisting
interstitial pneumonia of other types was made, based on pathological evidence of airspace enlargement with
fibrosis and organizing diffuse alveolar damage. Treatment with high-dose
methylprednisolone followed by tapered oral
prednisolone resulted in gradual improvement of the clinical condition and chest radiographic findings. Clinicians should be aware that patients with airspace enlargement with
fibrosis may experience acute exacerbation.