Abstract
We report a rare case acute responded idiopathic interstitial pneumonia (IIP), who to treatment with corticosteroids, but developed acute exacerbation after a second bronchoalveolar lavage (BAL). A 67-year-old woman with liver cirrhosis and diabetis mellitus was admitted on November 8th, 1993, for detailed examination and treatment of cough, dyspnea and abnormal lung shadows. The chest X-ray film on admission showed hazy densities in both lung fields. Though the administration of diuretics, antibiotics, and oxygen were not effective, pulse therapy with methyl-predonisolone (1g/day in three days) was effective. After the 2nd pulse therapy course, BAL was performed again. Transbronchial lung biopsy specimen revealed findings of interstitial pneumonia. We diagnosed this case as acute type IIP. After the 2nd procedure BAL, she complained of severe dyspnea, and hazy densities in both lung fields progressed worse. In spite of extensive treatment including corticosteroid therapy, she died of respiratory failure due to acute exacerbation of IIP. Though acute exacerbation of IIP after BAL is a relatively rare complication, when it dose occurr, it may become a fatal complication as in the present case. It is nesesarry for carefully decide on indication of BAL in patients with acute type of IIP.
