Arterial blood gas values with the patient receiving 3 L O/min by nasal cannula showed a pH of 7.46, Pco, of 17 mm Hg, and a Po2 of 111 mm Hg. The admission chest roentgenogram showed diffuse pulmonary interstitial infiltrates (Fig 1). The IgC, IgM, IgA, and IgE levels were normal. The C3, C4, and CH100 (total complement) were normal, as were the T, B, and NK cell counts, and helper-suppressor ratios. Skin tests using histamine and an extrac t of Aspergillus fumigatus were negative. Bronchoalveolar lavage yielded a total cell count of 18 x 10“ in a volume of 24 ml with 22 percent macrophages, 11 percent lymphocytes, 40 percent neutrophils, and 27 percent eosinophils. No fungal forms were seen on microscopic examination of the BAL effluent.
Serum and BAL fluid failed to demonstrate precipitating antibodies to A fumigatus; serum was also sent to another laboratory. The patients dyspnea increased, and treatment with methylpred-nisolone (1 m^kg intravenously every 6 h) was initiated on the third hospital day. His clinical condition improved within two days, and antibiotics and oxygen were discontinued. A chest roentgenogram on the seventh hospital day showed marked resolution of the diffuse infiltrates. No bacteria, fungi, or viruses grew from blood or BAL fluid cultures. The patient was discharged home the following day, taking a daily dose of 60 mg of prednisone.
Figure 1. The admission chest roentgenogram demonstrates diffuse interstitial infiltrates.