THE VALUE OF OPEN LUNG-BIOPSY IN IMMUNOCOMPETENT PATIENTS WITH COMMUNITY-ACQUIRED PNEUMONIA REQUIRING HOSPITALIZATION

Objective: To determine the role of open lung biopsy in immunocompeten t patients with community-acquired pneumonia who require hospitalizati on. Design: A group of 1,118 patients with severe community-acquired p neumonia that required hospitalization were enrolled in the study. Of the patients, 26 underwent open lung biopsy. Another 18 of these patie nts were immunocompromised and were excluded from this segment of the study. Setting: Tertiary care 800-bed hospital from November 1981 to M ay 1989. Results: Progressive diffuse pulmonary infiltrates and negati ve conventional cultures were the indications for biopsy in most of th ese patients. Eighteen (69 percent) were immunocompromised. The eight immunocompetent patients underwent a retrospective review of their cou rse in hospital. Three patients died. The diagnostic yield from open l ung biopsy was 25 percent. A specific histologic diagnosis was made in one patient-lipoid pneumonia. The pulmonary histologic finding were n onspecific in the remaining patients, but in four, in combination with the clinical data, gave useful information and resulted in therapy ch ange. Culture of a pulmonary tissue yielded cytomegalovirus in one oth er patient. Serologic testing had a low yield in this group with three patients having a positive result. Conclusions: Open lung biopsy is r arely necessary in immunocompetent patients with community-acquired pn eumonia. In a small group of patients where it is necessary, however, both positive and negative results are important in directing therapy.