Full blood examination demonstrated an eosinophilia 20x the upper limits of normal. Parasitic and fungal screens were negative. No recent antibiotic use. The patient proceeded to bronchoscopy:
Specimen Type: Broncho-alveolar Lavage
MACROSCOPIC DESCRIPTION: 10ml cloudy colourless fluid.
MICROSCOPIC DESCRIPTION: The smears contain scattered alveolar macrophages in a background of abundant eosinophils. No fungal elements demonstrated on Grocott stain. No features present to suggest alveolar proteinosis. No malignant cells are identified.
DIFFERENTIAL CELL COUNT
- Alveolar macrophages 27% (83-94%)
- Lymphocytes 02% (5-16%)
- Neutrophils 0% (1-6%)
- Eosinophils 71% (0-1%)
- Bronchial cells 0% (0-5%)
DIAGNOSIS: Broncho-alveolar Lavage: Marked eosinophilia. Negative for malignancy.