Subclinical pulmonary involvement assessed by bronchoalveolar lavage in patients with early undifferentiated connective tissue disease

Objective To assess the presence of neutrophil and lymphocyte fibrosing alv eolitis by bronchoalveolar lavage in patients with early undifferentiated c onnective tissue disease (EUCTD) and systemic sclerosis (SSc). Method Bronchoalveolar lavage (BAL) was performed in 13 patients with EUCTD who exhibited signs of lung involvement by non-invasive methods including lung function tests and high resolution computed tomography. The mean age o f cases was 48.1 +/- 6.6, and the mean disease duration was 1.8 +/- 0.8 yea rs. Differential cell counts of BAL were evaluated. Eleven patients with sy stemic sclerosis and 5 healthy control subjects were also investigated. Results Eleven of the 13 EUCTD and 10 of the 11 SSc patients showed an elev ated total cell number (above the median cell/ml of control + 2SD) in the B AL fluid. In patients with EUCTD, the lymphocyte count was elevated in 6, a nd the polymorphonuclear neutrophil count in 2 patients. One of the patient s with EUCTD had simultaneously elevated lymphocyte and neutrophil granuloc yte counts. In the SSc group, 6 patients had an elevated lymphocyte and 6 a n increased neutrophil count. Three of these cases had both increased neutr ophil and elevated lymphocyte counts, simultaneously. Conclusion Subclinical, predominantly lymphocyte alveolitis can be present in patients with EUCTD. Patients with SSc tend to exhibit neutrophil alveol itis.