Sripavatakul and Foocharoen Journal of Medical Case Reports 2011, 5:309 http://www.jmedicalcasereports.com/content/5/1/309 Page 2 of 6 Figure 1 Chest radiograph showing interstitial infiltration in both lower lung fields. left ventricular hypertrophy without pulmonary arterial hypertension. Since our patient’s symptoms had worsened, the attending physician prescribed oral daily cyclophospha- mide (100 mg per day) plus prednisolone (10 mg per day). Within three months, the clinical symptoms improved; however, the follow-up FVC was minimally decreased with an FVC of 45% and an FEV1/FVC of 90%. Cyclophosphamide was stopped after one year of treatment and the steroid tapered off during follow-up. One year after stopping the cyclophosphamide–but while still on the prednisolone–the symptoms of dys- pnea upon exertion returned. A radiograph and HRCT of the chest were therefore repeated to ascertain the cause of dyspnea. We observed increased thickening of the interlobular septa with sub-pleural emphysema and tubular bronchiectasis of his right lower lung (Figures 3 and 4). Supportive treatment with low-flow oxygen ther- apy and breathing exercises were prescribed because of the chronic pulmonary fibrosis. Our patient was admitted because of a low-grade fever with pleuritic chest pain, progressive shortness of breath, and a productive cough of five days duration. On physical examination, he had tachypnea (28 breaths/ Figure 2 HRCT chest scan revealed minimal thickening of the interlobular septa with thickening of the pleura in both lungs and mild bronchiectasis in both lower lungs.