CYTOLOGIC DIAGNOSIS OF RESPIRATORY SYNCYTIAL VIRUS-INFECTION IN A BRONCHOALVEOLAR LAVAGE SPECIMEN FROM A BONE-MARROW TRANSPLANT RECIPIENT

Cytologic examination of a bronchoalveolar lavage specimen from a 6-ye ar-old bone marrow transplant recipient revealed pulmonary infiltrates and occasional cells containing discrete pink cytoplasmic inclusions on a May-Grunwald-Giemsa stain. Direct immunofluorescence stains of cy tospins prepared from the same specimen were positive for respiratory syncytial virus (RSV). Electron microscopy revealed occasional epithel ial cells with cytoplasmic inclusions composed of filamentous virions. The patient died 6 months after the specimen was taken. An autopsy sh owed ongoing bronchiolitis with diffuse alveolar damage. Occasional br onchiolar epithelial cells contained discrete eosinophilic cytoplasmic inclusions, which on ultrastructural examination proved to be compati ble with RSV. Examination of bronchoalveolar lavage fluid from bone ma rrow transplant recipients should include a search for cytopathic chan ges compatible with RSV infection. Electron microscopy can be helpful in confirming this diagnosis.