CASE PRESENTATION: A 55 year-old African American female presented with six months of worsening dyspnea, shortness of breath, and fatigue. One year prior, she had been diagnosed with pulmonary hypertension after a right heart catheterization (MPAP 71 mmHg, PCWP 14 mmHg). At that time, she was started on home oxygen and oral sildenafil. High-resolution computed tomography (HRCT) showed findings of extensive bibasilar ground-glass opacities, subpleural reticulation, and intraseptal thickening (Fig. 1). Pulmonary function tests showed reduced diffusing capacity. An extensive rheumatology work-up was notable only for a mildly elevated rheumatoid factor. A video-assisted thorascopic surgical (VATS) lung biopsy was requested but was declined by thoracic surgery due to operative risk. Therefore, a transbronchial cryobiopsy of the left lower lobe was performed under general anesthesia. The patient remained intubated in the intensive care unit for 1 day and was discharged 5 days later on high-dose oral steroids and inhaled trepostinil. Pathology was consistent with non-specific interstitial pneumonia (NSIP) (Fig. 2). She was continued on steroids with improvement in her symptoms and later switched to oral azathioprine.