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©2013 UpToDate ® Print Email Diagnostic value of bronchoalveolar lavage in drug-induced lung disease Typical findings in BAL Typical findings in BAL Drug Cytotoxic reactions Atypical cells (cytomegaly, cytoplasmic eosinophilia, bizarre cell shape, nuclear hyperchromasia, prominent nucleoli, multinucleation) Chemotherapeutic agents: bleomycin, methotrexate, nitrosoureas, busulfan, cyclophosphamide Increased eosinophils Extracellular lipoproteinaceous debris Pulmonary hemorrhage Hemosiderin-laden alveolar macrophages D-penicillamine, mineral oil, amphotericin B Red blood cells Lymphocytic alveolitis 40 to 50 percent lymphocytes Methotrexate, nitrofurantoin, azathioprine, sulfasalazine, cyclophosphamide, amiodarone Increased CD8+ cells suggestive of hypersensitivity reactions Decreased CD4+ to CD8+ ratio BCG therapy, acebutolol, gold salts, propranolol, busulfan, nilutamide, bleomycin, flecainide Neutrophilic alveolitis Increased neutrophils Bleomycin, busulfan Eosinophilic alveolitis Allergic "eosinophilic" reactions Nitrofurantoin, penicillin, sulfasalazine, ampicillin, tetracycline, bleomycin, clotrimazole Lipoid pneumonia Alveolar macrophages contain large empty vacuoles stained by Oil-Red-O Mineral oil nose-drops or laxatives Thesaurismosis Accumulation of numerous large lamellar inclusions mainly in alveolar macrophages Amiodarone Potentially all amphiphilic drugs BAL: bronchoalveolar lavage. Data from King TE, Jr. Interstitial Lung Disease. In: Feinsilver SH, Fein AM. (Eds), Textbook of Bronchoscopy, Williams & Wilkins, Baltimore, 1995, p. 185-220.