Bronchoalveolar lavage cell data in drug-induced pneumonitis

In an attempt to evaluate the diagnostic help of bronchoalveolar lavage cell data in drug-induced pneumonitis (D.I.P.), we collected through the world literature 167 cases of D.I.P. In 122 cases, data were available for individual analysis (68 associated with amiodarone prescription and 54 with other drugs). 28 drugs were incriminated. Apart from 13 cases with normal BAL cell profile, the most prominent feature in the other 109 was a lymphocyte alveolitis either pure or associated with neutrophil and/or eosinophil alveolitis along with an imbalance in T-lymphocyte phenotype. These characteristics closely resembled those observed in hypersensitivity pneumonitis due to inhalation of organic dust. Nonetheless, about one third or more of cases displayed no lymphocytosis but neutrophil and/or eosinophil alveolitis. Taken together, these findings are in no way specific for D.I.P. but could be of interest to help diagnosis and understanding of iatrogenic alveolitis, especially when a provocation test coupled with sequential BAL is performed.