Diffuse pulmonary infiltrates in immunocompromised patients. Reconciling theory and practice

Management of immunocompromised patients with diffuse pulmonary infiltrates remains a common and stubbornly difficult problems. The range of diagnostic possibilities is wide, noninvasive diagnostic procedures have little utility, and the drugs available for empirical therapy have toxic effects that are sometimes severe. Although guidelines for management have been developed, they may be predicated on data from a single institution or depend on diagnostic procedures and laboratory support that are not necessarily available to physicians in all locations. Controversy exists as to whether making a definitive diagnosis in these patients has an impact on overall outcome. An individualized approach must consider local resources, the patient's age and prognosis, type of immunosuppression, opinions of patient and family regarding invasive measures and heroic support, and previous patterns of infection in the institution. Before invasive procedures are performed, thought must be given to what changes in treatment may be made when results are known. Familiarity with and critical appraisal of the literature on pulmonary infiltration in immunocompromised patients can contribute to a clear diagnostic and management plan.