A Rare Case: Nonspesific Interstitial Pneumonia Associated with Viral Pneumonia

Nonspesific interstitial pneumonia (NSIP) is an interstitial pulmonary disease mostly effecting women between ages 40-50. Although known as idiopathic, NSIP is generally seen among patients with connective tissue disorders like systemic sclerosis, autoimmune myositis and hypersensitivity pneumonitis. The most common radiographic findings on computer tomography (CT) are bilateral ground glass opacities and fibrotic infiltrates. We are presenting a case of NSIP following viral pneumonia. 43 year-old, previously healthy caucasian male, was admitted to emergency clinic with acute on-set dyspnea. Since he was tachypneic and hypoxemic, he was taken to intensive care unit (ICU) and was internalised for 42 days. CT revealed diffuse ground glass opacities and Rhinovirus was detected in his nasal real-time polymerase chain reaction (PCR) test. Antiviral and antibiotic treatment was given in ICU. He was then transferred to ward and after being observed for one week he was externalised from the hospital. At his first follow-up visits, he was still dyspneic although not hypoxemic. His pulmonary function test (PFT) revealed a restrictive pattern with FVC:2.86 (%58) FEV-1:2.57(%65) FEV-1/FVC:89.7 DLCO:3.24 (%31). Ground glass opacities and fibrosis with preserved subplevral space was seen in control CT. Bronchoalveolar lavage was inconclusive so transbronchial cryobiopsy was performed. Pathology was consistent with mixed type NSIP with subacute variations. Since his chest x-ray dated 4 months before hospitalization was totally normal, new findings were thought to be related to viral pneumonia. The patient was started on methylprednisolone. He has clinically, radiologically and functionally improved. His PFT results after taking methylprednisolone for five months: FVC:3.75 (%77) FEV-1:3.17 (%81) FEV-1/FVC: 84 DLCO:4.97 (%48). There is no case showing association between viral pneumonia and NSIP in literature. We would like to state that from now on; before calling NSIP cases idiopathic viral pneumonia should come to mind as a cause.