A case of an 81-year-old with cough and dyspnea.

It is uncommon to diagnose usual interstitial pneumonitis as a unilateral presentation. We present a case of an 81-year-old current smoker who presented with exertional dyspnea and dry cough. The patient had right sided UIP pattern in the CT chest along with hiatus hernia. The etiology for the unilateral lung involvement was postulated to be due to the hiatus hernia leading to gastro-esophageal reflux disease (GERD) which caused micro aspirations leading to lung injury and fibroblast activation. Whether this can be prevented by anti-reflux medications needs further research. Our patient was managed with pirfenidone, metered dose inhalers containing tiotropium and proton-pump inhibitors Thus, a high index of suspicion for underlying gastro-esophageal reflux must be kept in such patients to arrive at an early diagnosis and start treatment.