616728, 105 PM ‘Acute interstitial pneumonia (Hamman-Rich syndrome) - UpToDate Definition — Acute interstitial pneumonia (AIP) is a rare and fulminant form of diffuse lung injury that generally occurs in previously healthy individuals, (See ‘Introduction’ above.) + Clinical features — The onset of AIP is usually rapid, with a prodromal illness of 7 to 14 days. The most common clinical signs and symptoms are fever, cough, and shortness of breath (See ‘Clinical features' above.) + Diagnosis — The diagnosis of AIP is based upon the presence of a clinical syndrome of idiopathic acute respiratory distress syndrome (ARDS) AND histologic confirmation of diffuse alveolar damage. (See ‘Diagnosis’ above.) * Differential diagnosis — The differential diagnosis of AIP includes heart failure, the diffuse alveolar hemorrhage syndromes, acute eosinophilic pneumonia, cryptogenic organizing pneumonia (also known as idiopathic bronchiolitis obliterans organizing pneumonia), hypersensitivity pneumonitis, and diffuse alveolar damage of known cause (table 1). (See ‘Differential diagnosis’ above.) + Treatment + Supportive care - The main treatment of AIP is supportive care. Noninvasive or invasive mechanical ventilation is often required, as most patients develop respiratory failure. (See ‘Supportive care’ above.) + Systemic glucocorticoids — For patients with a diagnosis of AIP, we suggest initiating high dose systemic glucocorticoids, although supportive data are limited (Grade 2C). We typically administer empiric broad-spectrum antibiotics simultaneously. (See ‘Glucocorticoids’ above.) * Prognosis — The in-hospital mortality from AIP is high (greater than 50 percent). Those who survive the initial ilIness may have substantial or complete recovery of lung function or may experience recurrence of AIP or the progression of chronic interstitial lung disease. (See 'Prognosis' abov hitps hvu uplodate.comicontentslacule-inerttial-pneumonia-hamman-ch-syndrome wn