Interstitial pneumonitis in the immunologically suppressed child: an urgent surgical condition.

Thirty-eight children were evaluated for interstitial pneumonia by open lung biopsy. In most instances the patients were immunosuppressed as a result of cancer chemotherapy and irradiation. Pneumocystis carinii infection was the most common cause of pneumonitis (60.4%), especially in children with leukemia (78.3%). The clinical triad of hypoxemia, tachypnea, and a diffuse interstitial infiltrate on chest x-ray, is an indication for early open lung biopsy. Survival was 91.7% in cases of acute pneumocystis pneumonia, a significant improvement over previous reports. These observations strongly support the concept of early open lung biopsy in the management of diffuse interstitial pneumonitis in patients who are immunosuppressed.