WEDNESDAY, Sept. 18, 2002 (HealthDayNews) -- By going the extra mile to diagnose the cause of a New York City firefighter's illness, doctors may have uncovered the cause of a rare type of pneumonia.
Dr. William N. Rom, a lung specialist at the New York University School of Medicine, treated the 38-year-old fireman, who was suffering from respiratory failure. The fireman, part of the 9/11 World Trade Center disaster response team, had been working 16-hour days for 13 days, inhaling huge amounts of dust and debris.
Although the fireman responded well to the combination of antibiotics and cortosteroids Rom had prescribed, the doctor still wasn't satisfied that he'd determined the cause of the illness. So, he performed another procedure to specifically diagnose what was in the fireman's lungs.
"The man was responding to the drugs, but we weren't sure if it was the antibiotics or the cortosteroids," Rom says.
By testing the contents of the fireman's lungs in a procedure called a bronchoalveolar lavage, Rom identified the inhaled particles that were filling his respiratory system. He also found white blood cells that are a marker for a seldom-seen disease. The result was a diagnosis of acute eosinophilic pneumonia, a rare non-bacterial type of pneumonia.
Rom's report on the finding appears in the September issue of the American Journal of Respiratory and Critical Care Medicine.
"The pneumonia was most likely due to fly ash," Rom says, adding that fly ash comes from gypsum from the wallboard used in buildings. The fireman also had fiberglass particles and asbestos fibers in his lungs.
Acute eosinophilic pneumonia is very rare, Rom says.
"The garden-variety pneumonia is caused by bacteria, but this type of pneumonia is due not to germs but to environmental hazards," he explains.
Writing in an editorial that accompanied the journal article, Dr. William S. Beckett notes it's common to treat firefighters who have been exposed to smoke inhalation or other types of fumes with a combination of antibiotics and cortosteroids. And they recover well.
The combination of the two types of drugs are used to treat both the respiratory failure and possible bacterial infection, says Beckett, a professor of environmental medicine at the University of Rochester in New York.
"But if we did the bronchoalveolar lavage, we could spare the antibiotics," he says.
"There have only been a few dozen cases of acute eosinophilic pneumonia diagnosed," says Beckett, and the disease has only been recognized for the past 15 years. "Dr. Rom has provided a little bit of information that this disease may be caused by inhaling things, and may be more common than we thought."
Beckett says there have been plenty of theories about the cause of the disease -- including smoking or dirt kicked up by dirt bikes -- but no one knows the cause.
A bronchoscopy, the procedure used in a bronchoalveolar lavage, isn't routine, however. It's usually performed only in the intensive care unit or the pulmonary department of a hospital, Beckett says. It involves sliding a flexible scope through the nose or mouth down to the lungs, where doctors can see what's there and extract material for testing.
"This will probably stimulate other doctors seeing patients with inhaled material to look further," Beckett says. "It could help them separate this disease from other conditions."
What To Do
A fact sheet on the different kinds of dust and contaminants found at the World Trade Center disaster site can be found at the New York Committee for Occupational Safety and Health. For an explanation of a bronchoscopy, such as the one used to treat the New York City fireman, visit the National Library of Medicine.
