Serial bronchoalveolar lavage studies in a patient with intra-alveolar fibrosis following Legionnaires' disease.

A 48-year-old male developed acute respiratory failure owing to Legionnaires' disease (LD). Antibiotic treatment including erythromycin and rifampicin was not effective, thus transbronchial lung biopsy was performed. The histological examination of the lung showed intra-alveolar fibrosis. Corticosteroid therapy was begun and he responded well with definite clinical improvement. Bronchoalveolar lavage (BAL) was performed three times in the following year. The first BAL showed an increase of lymphocytes which then decreased significantly in the following studies. This case report thus demonstrates the importance of lung biopsy of protracted LD and the usefulness of BAL in the assessment of corticosteroid therapy.