title: Usefulness of bronchoalveolar lavage for the diagnosis and treatment of refractory pneumonia in a patient with Kostmann syndrome, a severe congenital neutropenia.
abstract: An 11-year-old girl with Kostmann syndrome developed refractory pneumonia. Culture of oral discharge, throat-swab specimens, and blood could not identity the causative organism, and systemic antimicrobial therapy failed to achieve improvement. We then performed diagnostic bronchoalveolar lavage (BAL) and culture of BAL fluid (BALF) yielded Pseudomonas aeruginosa. Therapeutic BAL using gentamicin produced a striking improvement of her pneumonia.
  
  
  CONCLUSIONS
  In immunocompromised children with pneumonia, BAL helps to identify the causative organism. If the patient is unresponsive to systemic antimicrobial therapy, BAL using antimicrobial agents is also worth trying.
authors.affiliation: Department of Pediatrics, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan. t-chiba@nms.ac.jp
authors.forename: T
authors.initials: T
authors.lastname: Chiba
authors.forename: J
authors.initials: J
authors.lastname: Hayakawa
authors.forename: T
authors.initials: T
authors.lastname: Ueda
authors.forename: M
authors.initials: M
authors.lastname: Migita
authors.forename: M
authors.initials: M
authors.lastname: Maeda
authors.forename: T
authors.initials: T
authors.lastname: Imai
authors.forename: M
authors.initials: M
authors.lastname: Takase
authors.forename: M
authors.initials: M
authors.lastname: Hida
authors.forename: Y
authors.initials: Y
authors.lastname: Fukunaga
mesh_terms: D018893:Bronchoalveolar Lavage; D002648:Child; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage; D006801:Humans; D009503:Neutropenia / Q000151:congenital*; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D011552:Pseudomonas Infections / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D013577:Syndrome; D016896:Treatment Outcome
chemical_list: D005839:Gentamicins