An unusual case of nonspecific interstitial pneumonia treated initially with surgical resection

Nonspecific interstitial pneumonia (NSIP) has been recently described as a distinct clinicopathologic entity. We describe an unusual case of a middle-aged man who presented with exertional dyspnoea, cough, radiographic airspace opacities in the left lung and previous history of right thoracotomy for suspected right lower lobe neoplasm. Histology at that time revealed "chronic inflammation". A course of high-dose steroids was given after failure of the airspace opacities to respond to a trial of antituberculous therapy. Improvement in symptoms and radiological appearance was noted subsequently. A diagnosis of nonspecific interstitial pneumonia was made on review of the initial open lung biopsy specimen. Seven months after tailing down to maintenance low-dose steroids, the NSIP relapsed. The NSIP subsequently responded again to high-dose steroids. This case illustrates that NSIP is a difficult diagnosis, may present as a focal lung opacity initially, and may relapse after steroid dose is tailed down.