Bronchoalveolar lavage in patients with atypical pneumonia

Background: Atypical pneumonia mimics diffuse interstitial lung disease (DILD) on chest x-ray and can progress to the lung fibrosis.

Patients and methods: 16 patients with DILD seen on chest X-ray.We performed BAL,bronchoscopic lung biopsy, serology for Mycoplasma pneumoniae, Chlamydia spp, Legionella spp and measurement of TLco.

Results: 9 patients with reticular opacities bilateral, 3 patients with reticular pattern and nodules, 2 with patients reticular pattern and BHL, 2 patients with ground glass and reticular opacity on chest x-ray. Interstitial pneumonia was diagnosed in 7 patients, interstitial and intraalveolar pneumonia in 2 patients, intraalveolar pneumonia in 3 patients, interstitial pneumonia with minimal fibrosis in 2 patients and in 2 patients histopathological results were normal. In 8 patient infection with Mycoplasma spp and in 8 patients infection with Chlamydia pn. was confirmed by serological results.In BAL there were alveolitis with average 19% neutrophils, 59% alveolar macrophages, 13% lymphocytes and 6% eosinophils. TLco was reduced in all smokers and in two nonsmokers. In 7 patients with lower TLco (59%) short course of methilprednisolon therapy was performed.

Conclusion: In our group of patients with atypical pneumonia neutrophils predominate in BAL and in patients with lower TLco the percentage of neutrophils was higher then in the group of patients with normal TLco.