ANSWERThe diagnosis of CEP is certainly very strongly suggested by the characteristic radiology elevated IgE and BAL results. In adults the diagnosis is generally made based on radiological appearance alone.
gold standard for diagnosis is a lung biopsy. Although this is a safe
procedure in experienced hands we felt sufficiently sure of the diagnosis
to make it without a lung biopsy. This point was discussed in detail
in rounds and there were some differences of opinion. One center said
that it is reasonable not to biopsy in the adult population but that
this criteria could not be applied to the pediatric population. Biopsy
following recurrence may show an altered disease pattern. Another center
said that the only role of the biopsy would be to exclude causes of
disease, which were excluded with the investigations already performed.
It was argued that a biopsy would not alter management in the patient
and for this reason it was felt to be an unnecessary procedure for the
child. If there is recurrence of the disease biopsy could be considered
at a later date.
WHAT MANAGEMENT WOULD YOU RECOMMEND FOR THIS PATIENT?