A 57-year-old woman presents with worsening shortness of breath over the course of six months. She has lost seven pounds in the past three months and has developed a nonproductive cough. She has never smoked, and has no known mold or work-related exposures. Her only pet is a cockatiel she has had for 18 months. HRCT demonstrates upper lobe predominant ground glass opacities in a mosaic pattern with centrilobular nodules. IGG precipitants for cockatiel droppings are positive.
What is the next best step in management?
A. High dose prednisone, followed by a taper
B. Surgical lung biopsy
C. Combined immunosuppression with prednisone and mycophenolate mofetil
D. Serological evaluation for evidence of connective tissue disease
C. Combined immunosuppression with prednisone and mycophenolate mofetil
D. Serological evaluation for evidence of connective tissue disease
E. Removal of cockatiel
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