Clinical Cases  ·  Pulmonary Vol. III  ·  Diffuse Parenchymal Lung Disease
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Pulmonary Disease

Diffuse Parenchymal Lung Disease

10 cases on [genuine one-line description of what this topic's real clinical territory covers] — choose a case below to open its full multi-voice debate.

Pulmonary DiseaseDiffuse Parenchymal Lung Disease
First-Line Antifibrotic Choice in Idiopathic Pulmonary Fibrosis

A retired surveyor newly diagnosed with IPF has three real antifibrotic options for the first time — the disagreement isn't whether to treat, but which of a newly approved drug and two long-established ones actually fits him.

Case 0001
Pulmonary DiseaseDiffuse Parenchymal Lung Disease
Progressive Fibrosis, No Settled Diagnosis: What Does “Despite Management” Require?

A patient with unnamed autoimmune-feature lung disease has real, physiologic decline but no failed treatment behind her — the disagreement is over what a diagnostic criterion written around a treatment trial actually requires when no treatment was ever tried.

Case 0002
Pulmonary DiseaseDiffuse Parenchymal Lung Disease
A Trial Finds Benefit, a Cohort Finds Harm: Antifibrotic Therapy in RA-ILD

A retired ironworker's new lung disease sits between a randomized trial that found benefit and a 2025 real-world study that found the opposite — the disagreement is about which kind of evidence to trust, not which drug exists.

Case 0003
Pulmonary DiseaseDiffuse Parenchymal Lung Disease
An Inflammatory Phenotype in Early Scleroderma: Tocilizumab or Mycophenolate First?

A newly diagnosed scleroderma patient's rising skin score and elevated inflammatory markers match a landmark trial's own inclusion criteria almost exactly — the disagreement is whether that match should override the broader, older standard of care.

Case 0004
Pulmonary DiseaseDiffuse Parenchymal Lung Disease
European Strategy or American Strategy: First Immunosuppression in Rapidly Progressive Antisynthetase-ILD

A physical therapist's new, rapidly worsening antisynthetase-syndrome lung disease sits between two named treatment traditions that a purpose-built trial has never finished comparing.

Case 0005
Pulmonary DiseaseDiffuse Parenchymal Lung Disease
Treatment Threshold and Steroid-Sparing Choice in Pulmonary Sarcoidosis, With a Pregnancy Ahead

An HVAC technician's slow decline from pulmonary sarcoidosis has finally crossed into treatment territory the same year he and his wife started trying to conceive — the printed advice on the standard steroid-sparing agent runs against that plan while the outcome data behind it do not.

Case 0006
Pulmonary DiseaseDiffuse Parenchymal Lung Disease
Burnt-Out but Still Declining: Antifibrotic Therapy in Fibrotic Sarcoidosis

Two decades into pulmonary sarcoidosis, a dedicated gardener's disease has stopped showing signs of active inflammation but keeps declining anyway — the disagreement is between two options neither of which is actually proven for her.

Case 0007
Pulmonary DiseaseDiffuse Parenchymal Lung Disease
When the Antigen Can't Be Fully Avoided: Treatment Strategy in Fibrotic Bird-Fancier's Lung

A widow can't fully give up the homing pigeons her late husband raised, and her chronic hypersensitivity pneumonitis keeps worsening despite partial avoidance — the disagreement is whether immunosuppression actually helps a disease this far along.

Case 0008
Pulmonary DiseaseDiffuse Parenchymal Lung Disease
A Guideline That Says “May Help” and a Cohort That Says It Didn't: Steroids in Acute Exacerbation of IPF

A man's known IPF has acutely worsened, and the same guideline recommending steroids as the only real option also recommends against the immunosuppression that made his underlying disease worse — the disagreement is about what a weak recommendation actually licenses.

Case 0009
Pulmonary DiseaseDiffuse Parenchymal Lung Disease
Three Years on a Drug the Guideline No Longer Recommends: Antacid Therapy in Stable IPF

A woman has taken a reflux drug for three years for a diagnosis she has never actually had — the disagreement is whether the guideline that once recommended it, then reversed itself, is reason enough to stop.

Case 0010
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