RAPID DIAGNOSIS OF ACUTE EOSINOPHILIC PNEUMONIA (AEP) IN A PATIENT WITH RESPIRATORY-FAILURE USING BRONCHOALVEOLAR LAVAGE (BAL) WITH CALCOFLUOR WHITE (CW) STAINING

A diagnosis of exclusion, acute eosinophilic pneumonia (AEP) is an acu te febrile illness with respiratory impairment, diffuse pulmonary infi ltrates, and bronchoalveolar lavage (BAL) fluid eosinophilia. Whether pulmonary eosinophilia in AEP is primary or secondary remains undeterm ined. We report here a 22-year-old auto mechanic with severe AEP and a cute respiratory failure who required intubation and ventilatory suppo rt. The patient's bronchoalveolar lavage (BAL) fluid was analyzed usin g cultures, cytology, Wright/Giemsa, Gram, Gomori-methenamine-silver ( GMS), and calcofluor white (CW) stains (1). Despite extensive evaluati on, no infectious etiology was found. CW staining helped us rapidly to exclude Pneumocystis carinii or fungal infection and to focus attenti on toward the diagnosis of AEP. Transbronchial biopsy was unnecessary and supportive therapy without systemic glucocorticoids was followed b y recovery within a few weeks. in this case, bronchoalveolar lavage wi th CW staining was of great assistance in the rapid diagnosis and init ial management of AEP. Our literature review found no prior article us ing CW staining for evaluation of AEP. (C) 1997 Wiley-Liss, Inc.