A 47-year-old woman was admitted to our hospital because of dry
cough,
fever, and subacute, progressive
dyspnea. Chest radiography and computed tomography showed ground glass opacities in the lower lung fields. We suspected
pneumonia caused by atypical pathogens and administered
antibiotics, but they had no effect at all. Histopathologic findings from a transbronchial lung biopsy (TBLB) included intensive infiltration of mononuclear cells and
edema on the alveolar wall with no evidence of
fibrosis, fibroblasts, hyaline membrane, or
granuloma. On the basis of these findings, we suspected
interstitial pneumonia, but a surgical lung biopsy was not possible because the patient would not give her consent. After TBLB,
corticosteroid was administered repetitively, but
dyspnea was deteriorating as the ground glass opacities became more widespread, and tractional
bronchiectasis appeared throughout the lung fields. Therefore, we decided to administer
cyclophosphamide (CPA). This was very effective: all of her symptoms improved and the ground glass opacities and tractional
bronchiectasis disappeared. Though we tapered and then discontinued
corticosteroids a few months after CPA, there was no recurrence whatever. No signs suggesting the association of
collagen vascular diseases were detected. The effectiveness of CPA in
interstitial pneumonia associated with
collagen vascular disease is occasionally reported, but the effect on
idiopathic interstitial pneumonia, especially in acute and subacute progressive cases, is rarely reported. We think this is an interesting case to consider the availability of CPA in
idiopathic interstitial pneumonia with subacute progression.