Abstract
Introduction: Value of bronchoalveolar lavage(BAL) in evaluating patients with vasculitis is without any doubt. BAL is performed in patients with diffuse parenchymal opacities on CT to assess for alveolar haemorrhage and to obtain samples for cytological and microbiological analysis. There are currently no guidelines regarding how to approach immunosuppressed vasculitis patients presenting with respiratory symptoms.
AIM: To assess the percentage of positive BAL performed in immunosuppressed vasculitis patients who presented with respiratory symptoms.
Method: Retrospective analysis of patients diagnosed with vasculitis who underwent BAL between 2011 and 2013. Twenty patients were identified. Hospital electronic record system and clinic letters were used for data collection. Patients were assessed in terms of primary diagnosis, presenting complaints, CT chest indications and findings, BAL findings and further management.
Results: Overall, 50% of BALs were positive. 18 CT scans were abnormal and 2 CT scans were normal with negative BAL. The abnormal findings on BAL included CMV, PCP, HSV, influenza, rhinovirus and corona virus, with several patients having multiple pathogens. Patients with negative BAL were treated for a flare of their vasculitis, community acquired pneumonia or pulmonary oedema, based on clinical judgement.
Conclusion: Early BAL is crucial in diagnosis and management of vasculitis patients presenting with respiratory symptoms and CT abnormalities. Negative CT scan could possibly predict negative BAL. With the results from BAL, confident treatment plans can be made and prolonged hospital admissions can be avoided. There is a need to establish local/international consensus guidelines.
- © 2014 ERS
