Interstitial pneumonitis occurs only rarely as a side-effect of HCV combination treatment and often leads to discontinuation of therapy, which has great implications for patients. In this article we presented our case of pneumonitis during combination therapy and performed a review in order to generate guidelines to manage symptoms and treatment. Given the paucity of reports with interstitial pneumonitis after ribavirin monotherapy, we suspect that interferon is the culprit. The most common presenting symptom of pneumonitis is any combination of dry cough, dyspnea, fever, and fine inspiratory crackles noted on examination. Hemoptysis, wheezing, and signs of consolidation are rare. Onset of pneumonitis can be at any stage of HCV treatment, supporting the idiosyncratic nature of this side-effect.