Abstract
Surfactant-related gene (SRG) variants are a rare but increasingly recognised cause of interstitial lung disease (ILD) in adults. Lung disease due to pathogenic variants in the adenosine triphosphate (ATP) binding cassette subfamily A member 3 (ABCA3) gene has been extensively described among infants and children but is rarely described in an adult population. The rarity and heterogeneity of lung disease due to ABCA3 variants raise significant challenges in recognition, diagnosis and management. In this case series we present three unique adult cases of ILD secondary to compound heterozygous ABCA3 variants, review the literature to provide an overview of this disease in an adult population and highlight the role for early genetic testing in young adults presenting with unusual ILD.