Bronchoalveolar Lavage Cells Findings in Patients with PIE Syndrome

A Suggestion Concerning Pathogenesis

Abstract

In this study, we examined the types of cells observed among alveolar inflammatory cells in PIE syndrome, obtained from bronchoalveolar lavage (BAL) and investigated which cells might attract eosinophils to the lung in PIE syndrome. Our working hypothesis was that if certain cells attract eosinophils to the lung these cells may increase in number in the lung. Furthermore, we examined the changes in the alveolar cell proportions during steroid therapy after abnormal shadows disappeared.
Bronchoalveolar lavage (BAL) cell characteristics were investigated in 12 cases with PIE syndrome (7 cases of PIE syndrome both before and during steroid therapy) as compared to 12 normal controls. Eight cases were prolonged type, 3 cases were asthmatic type and one case was simple type according to Crofton's classification.
The results were as follows.
The following characteristic findings for BAL cells were seen in patients with PIE syndrome:
1) Marked increases of total BAL cell numbers and eosinophil counts.
2) The eosinophil proportion was usually much higher in BAL than in peripheral blood.
3) Lymphocyte counts were elevated.
4) Basophils were found in the BAL fluid of 6 patients and basophil counts were elevated.
Characteristic findings on BAL cells in patients with PIE syndrome during steroid therapy were:
1) Normalization of total BAL cell numbers and eosinophil counts.
2) Lymphocyte counts remained elevated.
The above results suggest that not only eosinophils but also lymphocytes, and in some cases basophils, play a role in the profile of PIE syndrome. Furthermore, there may be a possibility that lymphocytes or basophils (mast cells) attract eosinophils into the lung in PIE syndrome.