This case demonstrates some of the typical features of fibrotic hypersensitivity pneumonitis (HP), although the imaging appearance can be somewhat variable. The presence of fibrotic changes such as coarse reticulations, traction bronchiectasis and honeycombing distinguish inflammatory from fibrotic HP. Diffuse axial distribution of changes and involvement of the central lung can be useful to help differentiate HP from other end-stage fibrotic lung diseases.