Step 2

Pulmonary 6

A 71-year-old man presents with complaints of a dry cough and progressive dyspnea on exertion for the past year. He is a former cigarette smoker with an 18 pack-year history. His respiratory symptoms worsened after having a SARS-CoV-2 infection approximately 6 months ago, for which she was treated as an outpatient with a 5-day course of nirmatrelvir/ritonavir (Paxlovid). He unfortunately developed “rebound COVID” though clinically asymptomatic at this time. He has a history of hypertension that is well controlled on hydrochlorothiazide (HCTZ). His family history is notable for his mother who died from “pulmonary fibrosis.” Review of systems is otherwise unremarkable with no occupational or environmental exposures. Physical examination is normal except for bibasilar crackles noted on lung examination. Comprehensive lab testing including an antinuclear antibody and rheumatoid factor are unremarkable. Pulmonary function testing shows a TLC 70%, FVC 70%, FEV1 75%, FEV1/FVC 84% and DLCO 70%. A high-resolution CT chest is performed with 2 images shown.

Which of the following is the best initial management of this patient's condition?

  • A) Azathioprine 150 mg daily
  • B) Lung transplant
  • C) Nintedanib (OFEV) 150 mg twice daily
  • D) Prednisone 60 mg daily for 1 month with slow taper
  • E) Rituximab intravenously every 6 months


Dr. Raj Dasgupta


Dr. Raj Dasgupta

Last updated

Nov 05, 2022

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