B BA AL L f fl lu ui id d L LD DH H a ac ct ti iv vi it ty y a an nd d L LD DH H i is so oe en nz zy ym me e p pa at tt te er rn n i in n l li ip po oi idIn addition to " "foamy" " alveolar macrophages, bronchoalveolar lavage (BAL) fluid analysis showed an increased number of neutrophils. Moreover, lactate dehydrogenase (LDH) and alkaline phosphatase activities were elevated. The increase seen in LDH activity both in serum and BAL fluid was accompanied by shifts in the isoenzyme pattern in similar directions for both fluids. These findings suggest a pulmonary source for the temporary serum as well as BAL fluid LDH increase.This case indicates the usefulness of bronchoalveolar lavage fluid analysis as a probe to detect pulmonary injury caused by a pneumotoxicant and, probably, to monitor recovery or deterioration. Eur Respir J., 1996Respir J., , 9, 2416 Case report A 30 year old man was transferred to our hospital from a local hospital. Eight hours before admission he had attempted suicide by injecting 10 mL of lamp oil (liquid paraffin) into a vein in his left elbow. On admission, no abnormalities were found. Over the following hours, the patient's respiratory condition deteriorated requiring mechanical ventilation.Chest radiography revealed a diffuse reticulonodular infiltrative process. A bronchoalveolar lavage (BAL) was performed 2 days after admission. Simultaneously, blood samples were taken. No bacteria were seen on Gramstained preparations and culture of BAL fluid remained sterile. Further analysis of the BAL fluid revealed an increased number of cells (32×10 4 cells·L -1 ; reference value for nonsmokers 10.3±1.5×10 4 cells·L -1 ), predominantly polymorphonuclear neutrophils (52%; reference value for nonsmokers 1.3±0.2%) [1].Cell-free supernatant from BAL fluid as well as serum were assayed for lactate dehydrogenase (LDH) and alkaline phosphatase activities. Additionally, protein and albumin contents were determined in cell-free BAL fluid and serum. In serum, the total protein and albumin levels were decreased (table 1). LDH activity was increased in serum to 795 U·L -1 (reference range 200-450 U·L -1 ) [2,3], as well as in BAL fluid (115 U·L -1 ; reference range 20-59 U·L -1 ) (table 1). Alkaline phosphatase activity in BAL fluid was high (145 U·L -1 ; reference range 0-25 U·L -1 ), whereas in serum it was within normal limits (table 1). At this moment, all other laboratory tests including liver function tests were normal. Moreover, on cytocentrifuged preparations of the BAL fluid stained with May-Grünwald-Giemsa (MGG; Merck, Darmstadt, Germany) numerous lipid-laden, "foamy" alveolar macrophages were seen.The diagnosis lipoid pneumonia was based on the clinical picture and the cytological analysis of BAL fluid.

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