Abstract
Non-fibrotic hypersensitivity pneumonitis (HP) is typically diagnosed based on characteristic chest computed tomography (CT) findings; however, cases complicated by emphysema, while rare, are diagnostically challenging. A 73-year-old man with 1 month of dyspnea showed diffuse emphysema and ground-glass opacities on CT. He was diagnosed with non-fibrotic HP based on bronchoalveolar lavage and histological findings, spontaneous symptom resolution, and positive serum-precipitating antibodies. His CT findings were atypical due to extensive emphysema, with low-attenuation areas exceeding those of typical HP cases at our hospital. Non-fibrotic HP with emphysema may be overlooked, highlighting the need for careful clinical and radiological evaluations.