Emergency lung biopsy in immunocompromised pediatric patients

Twenty-six lung biopsies were performed on immunocompromised children with interstitial pneumonia over a 4-year period. More than 50% of the patients had either bone marrow transplants or immunodeficiency syndromes. Biopsy diagnosis included viral (9), nonspecific interstitial pneumonitis (9), Pneumocystis carinii (7), and bacterial (1) etiologies. Findings caused a change in treatment in 15 (58%) patients, and nine of these 15 (60%) survived. Survivors included five children with viral infections treated with antiviral agents. Only one of nine patients requiring preoperative intubation survived, while 11 of 17 (65%) not intubated before operation survived. Overall survival was 46% and included 5 of 5 patients with leukemia, 2 of 3 patients with liver transplants, 2 of 6 patients with immunodeficiency syndromes, and 1 of 8 patients with bone marrow transplants. This report shows that (1) an infectious etiology was found in 65% of the cases; (2) there was a high incidence of viral pneumonitis; (3) biopsy indicated a change in treatment for the majority of the patients; (4) the change in treatment was associated with survival in 60%; (5) viral infections may be effectively treated; and (6) the timely use of lung biopsy is an important adjunct in the diagnostic and therapeutic regimen for immunocompromised children with interstitial pneumonia.