Bronchoalveolar lavage in hypersensitivity pneumonitis: a series of 139 patients.
Hypersensitivity pneumonitis (HP) is characterized by a lymphocytic alveolitis, classically delineated by an increase of CD8+ lymphocytes, with an inversion of the CD4+/CD8+ ratio. The aim of this study is both to describe the yield and cell bronchoalveolar lavage (BAL) profile and to revisit the assumption of low BAL CD4/CD8 ratio in the diagnosis of HP. A multicentric study was conducted on 139 patients who fulfilled the standardized diagnostic criteria of HP, mainly affected by farmer's lung. Mean total cell count in BAL fluid was 594 ± 401.10(3) cells /ml. Prominent absolute lymphocytic alveolitis, moderate neutrophilia, and mild eosinophilia and mastocytosis were found. Mean CD4/CD8 ratio was 3.8 ± 6.1 (median 2.1). Thirty four percent of the patients showed lymphocytic CD8 alveolitis (ratio < 1). The CD4/CD8 ratio was not different between forms, etiologies of HP, and time elapsed since last antigen exposure, but was higher in women (p=0.02). BAL in HP shows high total cell and lymphocyte counts, moderate neutrophilia, and mild eosinophilia and mastocytosis. An absence of low CD4/CD8 ratio should not at all exclude diagnosis.
Pulmonary Department, Gabriel Montpied Hospital, Montalembert Street, BP 69, 63003-Clermont- Ferrand, France. dcaillaud@CHU-clermontferrand.fr
Denis M
DM
Caillaud
Jean M
JM
Vergnon
Anne
A
Madroszyk
Boris M
BM
Melloni
Marlene
M
Murris
Jean C
JC
Dalphin
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000542:Alveolitis, Extrinsic Allergic / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology*; D018893:Bronchoalveolar Lavage / Q000379:methods*; D001992:Bronchoalveolar Lavage Fluid / Q000276:immunology*; D016516:CD4-CD8 Ratio / Q000379:methods; D005203:Farmer's Lung / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult