Sequential changes in bronchoalveolar lavage cells and cytokines in a patient progressing from acute to chronic bird Fancier's lung disease.

A 65-year-old pigeon breeder who presented with acute hypersensitivity pneumonitis refused to give up contact with pigeons and her lung disease, which had initially improved in hospital in response to removal from pigeons, progressed to chronic interstitial fibrosis. Bronchoalveolar lavage lymphocytes fell from 50.0% of total cells in December 1986 to 27.1% in February 1990. The ratio of CD4+/CD8+ lymphocytes shifted from 0.43 to 1.47. Furthermore, IL-6 and TNF-alpha were elevated initially and were much higher at the second time point. These data pointed to the importance of CD4+ lymphocytes, IL-6 and TNF-alpha in the development of pulmonary fibrosis.