BAL may aid in the diagnosis of eosinophilic pneumonia and has been advocated as an alternative to lung biopsy.” This approach is supported by Allen et al in their description of four patients with acute eosinophilic pneumonia who were successfully treated with corticosteroids. In the light of the present case, however, we would recommend open lung biopsy in addition to BAL in all cases of acute eosinophilic pneumonia.
Pseudomonas cepacia is an unusual cause of septicemia in pediatric patients, but may be accounted for on the basis of the immunosuppressive effects of corticosteroids. Corticosteroids may increase the incidence of pulmonary aspergillosis in laboratory animals, but the role of antibacterials in predisposing to invasive fungal disease is unclear.
Although local invasion in the presence of a hypersensitivity response has been described, it is impossible to determine whether our patients invasive pulmonary aspergillosis resulted from the inhalation of a large amount of Aspergillus spores followed by corticosteroid therapy, or whether therapy only aided the advancement of a primary invasive process. Although corticosteroids are helpful in eosinophilic lung diseases, immunosuppression may occur and allow for progression of illness, with potentially fatal consequences.