Increased Neutrophils in Bronchoalveolar Lavage Fluid from a Patient with Developing Adult Respiratory Distress Syndrome

Abstract

A 16-year-old, 28-week pregnant woman was admitted to our hospital with multiple bone fractures caused by traffic accident. She had massive blood transfusion because of anemia in her laboratory findings and ritodrine hydrochloride was administered because of the fear of threatened abortion. She developed cough with bloody sputum as the 4th day after admission, and developed pulmonary insufficiency with PaO₂ 41.0torr and presented bilateral diffuse infiltrates on chest roentgeograms on the next day.
Swan-Ganz catheterization revealed normal pulmonary capillary wedge pressure and analysis of the lavage fluid from the patient showed an increase in the percentage of neutrophils (40.0%) and the existence of leukotriene B4 which is known to be the most potent chemokinetic and chemotactic agent for neutrophils.
Her condition was considered to be permeability edema developing adult respiratory distress syndrome (ARDS) and 1g/day of methylpredonisolone was administered intravenously for 3 days, which brought about remarkable improvement of her respiratory failure.
This report suggests that analysis of the lavage fluid may provide useful information for the early diagnosis of ARDS and the indications of corticosteroid treatment.