The differential diagnosis of diffuse pulmonary infiltrates in the immunocompromised patient is difficult at best. In addition to a large variety of infectious agents, one must also consider that recurrence of the primary disease, drug toxicity, the adult respiratory distress syndrome, and toxic reactions to radiation therapy that may produce similar clinical and roent-genographic findings. Even when all these possibilities have been exhausted, one is often left with a small number of patients with interstitial disease of unknown cause. The present study examined the BAL findings in two groups of such immunocompromised patients in an area that is endemic for coccidioidomycosis. In keeping with the findings of several recent reports, the most common finding among AIDS patients was Pneumocystis pneumonia. Among the 35 BALs in 30 such patients examined, 26 were cytolo-gically positive for this organism. buy ortho tri-cyclen
All identifications were made with Pap stains prepared within 1 h of the bronchoscopic procedure, similar to previous reports. No additional diagnoses were made with GMS preparations, although the initial diagnosis was confirmed in each instance. The ease of the Pap preparation and the fact that identification was made by pathology residents on nights and weekends with 100 percent accuracy was an additional positive factor in the use of the Pap stain. Another advantage of this stain was the fact that a number of other organisms could be identified simultaneously. Fungi such as C immitis, cryptococci, and some species of Candida were frequently seen. Also, it was possible to recognize atypical or neoplastic cells, old hemorrhage, and other cytologic changes that contributed to the diagnostic conclusions. The GMS stains are still used to identify some fungi that may be missed with Pap staining and to confirm results.