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Sixty-one diagnostic biopsies for Pneumocystis cariniipneumonia were performed on 40 homosexual male patients with acquired immunodeficiency syndrome (AIDS), using flexible fiberoptic bronchoscopy. Bronchial brushings and bronchoalveolar lavage were performed in conjunction with the biopsy in 58 and 29 bronchoscopies, respectively. Using a rapid methenamine silver stain, P cariniipneumonia was diagnosed in 27 (68 percent) of the patients. Twenty of these patients had a repeat biopsy one or more times for evaluation of therapy. Eighteen of the biopsies following two to three weeks of therapy were positive. There was an 84 percent correlation between findings on transbronchial brushing and biopsy (89 percent on initial biopsy before treatment) and an 86 percent correlation between bronchoalveolar lavage and biopsy. Additionally, transbronchial brushing permitted demonstration of Pneumocystis organisms in four follow-up bronchoscopies in which the biopsy was negative or inadequate. Rapid methenamine silver stain of transbronchial brushings permits diagnosis of P cariniipneumonia in patients with AIDS within one-half hour of bronchoscopy.

We report a case of classic Wegener’s granulomatosis. Direct immunofluorescent study showed finely granular deposits of IgG and IgM in some of the alveolar walls, and of IgM in the maxillary sinus arteries. Electron-microscopic study of the lung and maxillary sinus showed intravascular fibrin, but failed to demonstrate electron-dense deposits in the blood vessel walls. Our patient also had circulating cryoglobulins, consisting of IgG, IgM, Clq, and C3, and evidence of circulating immune complexes as demonstrated by the Clq-binding test. These findings suggest that circulating immune complexes may play an important role in the pathogenesis of the respiratory lesions of Wegener’s granulomatosis.