A 48-year-old male developed acute respiratory failure owing to Legionnaires' disease (LD). Antibiotic treatment including erythromycin and riphampicin was not effective, thus transbronchial lung biopsy was performed. The histological examination of the lung showed intra-alveolar fibrosis. Corticosteroid therapy was begun and he responded well with definite clinical improvement. Bronchoalveolar lavage (BAL) was performed three times in the following year. The first BALshowed an increase of lymphocytes which then decreased significantly in the following studies. This case report thus demonstrates the importance of lung biopsy of protracted LDand the usefulness of BALin the assessment of corticosteroid therapy. (Internal Medicine: 32: 659-662, 1993)
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