Pneumocystis pneumonia: the importance of early open lung biopsy

Pulmonary infection due to Pneumocystis carinii is now recognized as the leading cause of death from infection in patients with a hematologic malignancy who are in remission. Effective treatment requires suspicion of the infection in susceptible patients and rapid identification of the organism. In most patients, open lung biopsy performed through a small anterior thoracotomy provides immediate identification or exclusion of the organism, thus allowing treatment of infected patients and avoidance of inappropriate therapy in patients without the disease. We feel that the use of early thoracotomy, in spite of the fact that it exposes these very ill patients to a major surgical procedure and general anesthesia, is ultimately the safest therapeutic course.