BRONCHOALVEOLAR LAVAGE CELL ANALYSIS IN A CHILD WITH CHRONIC LIPID PNEUMONIA

In an asymptomatic 4 yr old child with radiographic evidence of parenc hymal lung disease, bronchoalveolar lavage (BAL) yielded the diagnosis of chronic lipid pneumonia caused by chronic aspiration of mineral oi l given as a laxative. BAL analysis showed a marked reduction in the t otal number of alveolar macrophages; almost 70% of these cells contain ed intracytoplasmic lipid vacuoles. It also disclosed lymphocytic (cyt otoxic/suppressor) alveolitis. A high percentage of lymphocytes expres sed antigen markers of activation (human leucocyte antigen (HLA)-DR), CD54 and CD25). BAL analysis 18 months after mineral oil intake reveal ed that lymphocytes bearing antigen markers of activation had markedly decreased whereas alveolar macrophages (normal and lipid-laden) had i ncreased. A subsequent whole lung BAL was considered unnecessarily inv asive in this otherwise healthy child.