Two cases of bronchiolitis obliterans organizing pneumonia, showing multiple infiltrative shadows, diagnosed by open lung biopsy, and a report of their BAL findings]

Two cases of bronchiolitis obliterans organizing pneumonia (BOOP) were diagnosed by clinical features and pathological findings of open lung biopsy specimens. Findings of repeated (bronchoalveolar lavage (BAL) fluid analysis were also reported. Case 1 was a 54 year-old woman complaining of dry cough and low grade fever. Multiple infiltrative shadows in both lung fields were pointed out on her chest roentgenogram. Case 2 was a 68 year-old woman with symptoms of cough, sputum and low grade fever. Her chest X-ray films also showed multiple infiltrative shadows bilaterally. Although various antibiotics were given to both patients, new shadows appeared on their chest films without any improvement of clinical symptoms or inflammatory findings. TBLB specimens obtained from the two cases showed the findings of organizing pneumonia. In each case, open lung biopsy was performed, and the pathological diagnosis was consistent with BOOP. However, exclusion of the possibility of eosinophilic pneumonia and lymphoproliferative disorders of the lung was somewhat difficult in case 1. BALF analysis showed an increased number of lymphocytes in both cases, 75% and 37% respectively. The inverted ratio of OKT4/OKT8 (0.71) in BALF of case 1 was similar to that of hypersensitivity pneumonitis. In spite of clinical and roentgenological improvement after steroid therapy, the abnormal BAL findings still remained. Therefore it is suggested that BAL may be a useful tool for monitoring the steroid treatment of patients with BOOP.