Friday, July 15, 2005

Follow up to Pulmonary infiltrates

I had the same thoughts and concerns that have been outlined. Dan raised a good question on HIV status and PCP would also be a concern in a young man with subactue dyspnea and alveolitis.
CBC was unremarkable and HIV and ANA were negative. I performed a bronch: PCP PCR was negative. TBBx revealed a non-diagnostic pneumonitis. BAL did not look like PAP but had 72% Lymphs (the rest were Macs) with 91% of those being T-Lymphs with 60% CD8 cells. His HP pannel was positive for several molds including Cladosporium and Penicillium (which we incidentally grew from the BAL?) and mixed feathers.
He gave away the birds and his family claned the barn while he was in the hospital. I did give him steroids to speed up resolution because he was pretty hypoxic.
He has followed up in the office twice already: his D/C room air oxymetry was ~93% nad it is now 97%. His first FVC was 61% and that has come up to 75% and DLCO increased from 33% ro 66%. He feels better and he is back to work.
With this BAL results and HP pannel, would you bother with any other diagnostic testing?

1 comments - CLICK HERE to read & add your own!:

Jennings said...

Well, with the history, the HRCT findings, the high CD8, and the positive HP panel to things he was exposed to on history, I would say you re quite done with any further diagnostic testing.