PMC6260442_01
A. Chest X-ray. Reticular shadows are seen with bilateral lung base and subpleural predominance in February 2017. Decreased lung volume is also seen.. B. Chest HRCT. Reticular shadows with bilateral lung base and subpleural predominance, interlobular septal thickening, and traction bronchiectasis. Honeycombing is also seen in February 2017. Decreased lung volume in the lower lobes is seen from the resultant contractile changes.
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Chest HRCT images showed extended reticulation (Fig. 1B).
Treatment course: FVC is 3880 ml in December 2015 and decreases to 3390 ml in February 2017. Administration of nintedanib starts in February 2017. In May 2017, FVC has risen to 3450 ml, and in November 2017, it has decreased to 3360 ml.
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Pulmonary function test findings, especially FVC, also declined (Fig. 2). FVC decline in February recovered 60 mL 3 months after treatment initiation, followed by milder decline. FVC decreased by 490 ml 13 months after the initial visit (-12.6%/13 months) and by 90 ml after 6 months of treatment (-2.6%/6 months) (Fig. 2).