18th February 2024

A 76-year-old farmer presents to the respiratory clinic with an 8-month history of progressive breathlessness

A 76-year-old farmer presents to the respiratory clinic with an 8-month history of progressive breathlessness. He states that he has had a dry cough for the past 12 months that settled while away for holidays. He experienced a fever and worsening of his shortness of breath each day after returning from work. He denies any weight loss.

Examination today reveals bibasal fine crepitations. CXR was normal. An HRCT performed showed a mixed mosaic attenuation pattern, ground-glass opacities, and honeycombing, predominantly affecting the upper lobes. Spirometry revealed a restrictive pattern. Blood tests revealed normal IgE levels and no specific antibodies towards Aspergillus fumigatus.

What is the likely underlying diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.