Advertisement

NONRESOLVING OR SLOWLY RESOLVING PNEUMONIA

  • Author Footnotes
    * Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan
    Tünay Kuru
    Footnotes
    * Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan
    Search for articles by this author
  • Author Footnotes
    * Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan
    Joseph P. Lynch III
    Footnotes
    * Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan
    Search for articles by this author
  • Author Footnotes
    * Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan
      Physicians are often confronted with the dilemma of nonresolving or slowly resolving pulmonary infiltrates in patients receiving antibiotics for suspected community-acquired pneumonia (CAP). Nonresolution or slow resolution of pneumonia may reflect inadequate antibiotic therapy, resistant or highly virulent organisms, impaired host defenses, nonbacterial causes, obstructing endobronchial lesions (including neoplasms), and a host of noninfectious causes. When should these alternative causes be considered in patients with nonresolving or slowly resolving infiltrates? How long should one wait before embarking on a costly investigation to evaluate reasons for nonresolution? What is the normal or expected rate of resolution for pneumonia? What is the “safe” time interval for expectant observation? These decisions should be guided by the natural history of pneumonias (with knowledge of specific pathogens) and various host factors. Although a staggering array of diseases and clinical syndromes can masquerade as CAP,
      • Corley D.E.
      • Winterbauer R.H.
      Infectious diseases that result in slowly resolving and chronic pneumonia.
      • Gross T.
      • Chavis A.D.
      • Lynch III, J.P.
      Noninfectious pulmonary diseases masquerading as community-acquired pneumonia.
      • Lynch J.P.
      • Sitrin R.G.
      Noninfectious mimics of community-acquired pneumonia.
      • Orens J.B.
      • Sitrin R.G.
      • Lynch III, J.P.
      The approach to non-resolving pneumonia.
      these are far outnumbered by true cases of pneumonia. In this article the authors discuss the patterns of radiographic resolution for CAP and host factors that influence natural history. They also review diverse noninfectious disorders that can mimic CAP, and present an approach to diagnosis and treatment.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.

      Subscribe:

      Subscribe to Clinics in Chest Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Adler B.D.
        • Padley S.P.
        • Muller N.L.
        • et al.
        Chronic hypersensitivity pneumonitis: High-resolution CT and radiographic features in 16 patients.
        Radiology. 1992; 185: 91-95
        • Adler B.D.
        • Padley S.
        • Miller R.R.
        • et al.
        High resolution CT of bronchioalveolar carcinoma.
        AJR Am J Roentgenol. 1992; 159: 275-277
        • Agusti C.
        • Ramirez J.
        • Picardo C.
        • et al.
        Diffuse alveolar hemorrhage in allogeneic bone marrow transplantation. A postmortem study.
        Am J Respir Crit Care Med. 1995; 151: 1006-1110
        • Akira M.
        • Kita N.
        • Higashihara T.
        Summer-type hypersensitivity pneumonitis. Comparison of high resolution CT and plain radiographic findings.
        Am J Roentgenol. 1992; 158: 1223-1228
        • Alasaly K.
        • Muller N.
        • Ostrow D.N.
        • et al.
        Cryptogenic organizing pneumonia: A report of 25 cases and a review of the literature.
        Medicine (Baltimore). 1995; 74: 201-211
        • Allen J.A.
        • Davis W.B.
        Eosinophilic lung diseases.
        Am J Respir Crit Care Med. 1994; 150: 1423-1438
        • Allen J.A.
        • Pacht E.R.
        • Gadek J.E.
        • et al.
        Acute eosinophilic pneumonia as a reversible cause of noninfectious respiratory failure.
        N Engl J Med. 1989; 321: 569-574
        • Atmar R.L.
        • Greenberg S.B.
        Pneumonia caused by Mycoplasma pneumoniae and the TWAR agent.
        Semin Respir Infect. 1989; 4: 19-31
        • Austrian R.
        • Gold J.
        Pneumococcal bacteremia with special reference to bacteremic pneumococcal pneumonia.
        Ann Intern Med. 1964; 60: 759-776
        • Badesch D.B.
        • King T.E.
        • Schwarz M.I.
        Acute eosinophilic pneumonia: A hypersensitivity pneumonia?.
        Am Rev Respir Dis. 1989; 139: 249-252
        • Bailey M.E.
        • Fraire A.E.
        • Greenberg S.D.
        • et al.
        Pulmonary histopathology in cocaine abusers.
        Hum Pathol. 1994; 25: 203-207
        • Barkley J.E.
        • Green M.R.
        Bronchioloalveolar carcinoma.
        J Clin Oncol. 1996; 14: 2377-2386
        • Barrera P.
        • Laan R.F.
        • van Riel P.L.
        • et al.
        Methotrexate-related pulmonary complications in rheumatoid arthritis.
        Ann Rheum Dis. 1994; 53: 434-439
        • Barrter T.
        • Irwin R.S.
        • Nash G.
        • et al.
        Idiopathic bronchiolitis obliterans organizing pneumonia with peripheral infiltrates on chest roentgenogram.
        Arch Intern Med. 1989; 149: 273-279
        • Bartlett J.G.
        • Mundy L.M.
        Current concepts: Community-acquired pneumonia.
        N Engl J Med. 1995; 333: 1618-1624
        • Berk S.L.
        • Holtsclaw S.A.
        • Wiener S.L.
        • et al.
        Nontypeable Haemophilus influenzae in the elderly.
        Arch Intern Med. 1982; 142: 537-539
        • Borthwick R.C.
        • Cameron D.C.
        • Philp Y.
        Radiographic patterns of pulmonary involvement in acute mycoplasmal infections.
        Scand J Respir Dis. 1978; 59: 190-193
        • Brolin I.
        • Wernstedt L.
        Radiographic appearance of mycoplasmal pneumonia.
        Scand J Respir Dis. 1978; 59: 179-189
        • Bruu Al.
        • Haukenes G.
        • Aasen S.
        • et al.
        Chlamydia pneumoniae infections in Norway 1981–1987 earlier diagnosed as ornithosis.
        Scand J Infect Dis. 1991; 23: 299-304
        • Buchheit J.
        • Rodgets G.
        • Feger T.
        • et al.
        Acute eosinophilic pneumonia with respiratory failure: A new syndrome?.
        Am Rev Respir Dis. 1992; 145: 716-718
        • Calabrese L.H.
        • Hoffman G.S.
        • Guillevin L.
        Therapy of resistant systemic necrotizing vasculitis. Polyarteritis, Churg-Strauss syndrome, Wegener's granulomatosis, and hypersensitivity vasculitis group disorders.
        Rheum Dis Clin North Am. 1995; 21: 41-57
        • Cameron D.C.
        • Borthwick R.N.
        • Philp T.
        The radiographic patterns of acute Mycoplasma pneumonitis.
        Clin Radiol. 1977; 28: 173-180
        • Carratala J.
        • Gudiol F.
        • Parrares R.
        Risk factors for nosocomial Legionella pneumophila pneumonia.
        Am J Respir Crit Care Med. 1994; 149: 625-629
        • Carrington C.B.
        • Addington W.W.
        • Goff A.M.
        • et al.
        Chronic eosinophilic pneumonia.
        N Engl J Med. 1969; 280: 787-798
        • Chryssanthopoulos C.
        • Cassimos C.
        • Panagiotidou C.
        Prognostic criteria in idiopathic pulmonary hemosiderosis in children.
        Eur J Pediatr. 1983; 140: 123-125
        • Churg A.
        • Ballas M.
        • Cronin S.R.
        • et al.
        Formes frustes of Churg-Strauss syndrome.
        Chest. 1995; 108: 320-323
        • Clayton F.
        The spectrum and significance of bronchioloalveolar cell carcinomas.
        Pathology Annual. 1988; 23: 361-394
        • Clyde Jr, W.A.
        Clinical overview of typical Mycoplasma pneumoniae infections.
        Clin Infect Dis. 1993; 17: S32-S36
        • Cohen A.
        • King Jr, T.E.
        • Downey G.P.
        Rapidly progressive bronchiolitis obliterans organizing pneumonia.
        Am J Respir Crit Care Med. 1994; 149: 1670-1675
        • Cohen-Tervaert J.W.
        The value of serial ANCA testing during follow-up studies in patients with ANCA-associated vasculitides: A review.
        J Nephrol. 1996; 9: 232-240
        • Colby T.V.
        Bronchiolar pathology.
        in: Epler G.R. Disease of the Bronchioles. Raven Press, New York1994: 77-100
        • Colby T.V.
        • Carrington C.B.
        Pulmonary lymphomas: Current concepts.
        Hum Pathol. 1983; 14: 884-887
        • Colby T.V.
        • Myers J.L.
        The clinical and histologic spectrum of bronchiolitis obliterans including bronchiolitis obliterans organizing pneumonia.
        Semin Respir Med. 1992; 13: 119-133
        • Columbo J.L.
        • Stolz S.M.
        Treatment of life-threatening primary pulmonary hemosiderosis with cyclophosphamide.
        Chest. 1992; 102: 959-960
        • Conesa D.
        • Rell J.
        • Valles J.
        • et al.
        Invasive aspergillosis: A life-threatening complication of short-term steroid treatment.
        Ann Pharmacol. 1995; 29: 1235-1237
        • Cooper Jr, J.A.D.
        • White D.A.
        • Matthay R.A.
        Drug-induced pulmonary disease: part 1; cytotoxic drugs.
        Am Rev Respir Dis. 1986; 133: 321-340
        • Cooper Jr, J.A.D.
        • White D.A.
        • Matthay R.A.
        Drug-induced pulmonary disease: part 2; noncytotoxic drugs.
        Am Rev Respir Dis. 1986; 133: 488-505
        • Copeland J.
        • Wieden M.
        • Feinberg W.
        • et al.
        Legionnaires' disease following cardiac transplantation.
        Chest. 1981; 79: 669-671
        • Cordier J.F.
        Cryptogenic organizing pneumonia.
        Clin Chest Med. 1993; 14: 677-692
        • Cordier J.F.
        • Loire R.
        • Brune J.
        Idiopathic bronchiolitis obliterans organizing pneumonia. Definition of characteristic clinical profiles in a series of 16 patients.
        Chest. 1989; 96: 999-1004
        • Cordier J.F.
        • Valeyre D.
        • Guillevin L.
        • et al.
        Pulmonary Wegener's granulomatosis: A clinical and imaging study of 77 cases.
        Chest. 1990; 97: 906-912
        • Cordonnier C.
        • Fleury-Feith J.
        • Escudier E.
        • et al.
        Secondary alveolar proteinosis is a reversible cause of respiratory failure in leukemic patients.
        Am J Respir Crit Care Med. 1994; 149: 788-794
        • Corley D.E.
        • Winterbauer R.H.
        Infectious diseases that result in slowly resolving and chronic pneumonia.
        Semin Respir Infect. 1993; 8: 3-13
        • Costabel U.
        • Teschler H.
        • Schoenfeld B.
        • et al.
        BOOP in Europe.
        Chest. 1992; 102: 14S-20S
        • Cotch M.F.
        • Hoffman G.S.
        • Yerg D.E.
        • et al.
        The epidemiology of Wegener's granulomatosis.
        Arthritis Rheum. 1996; 39: 87-92
        • Coudert B.
        • Bailley F.
        • Lombard J.N.
        • et al.
        Amiodarone pneumonitis: Bronchoalveolar lavage findings in 15 patients and review of the literature.
        Chest. 1992; 102: 1005-1112
        • Crouch E.
        • Persson A.
        • Chang D.
        Accumulation of surfactant protein D in human pulmonary alveolar proteinosis.
        Am J Pathol. 1993; 142: 241-248
        • Dalhoff K.
        • Maass M.
        Chlamydia pneumoniae pneumonia in hospitalized patients.
        Chest. 1996; 110: 351-356
        • Daum T.E.
        • Specks U.
        • Colby T.V.
        • et al.
        Tracheobronchial involvement in Wegener's granulomatosis.
        Am J Respir Crit Care Med. 1995; 151: 522-526
        • Davison A.G.
        • Heard B.E.
        • McAllister W.A.C.
        • et al.
        Cryptogenic organizing pneumonitis.
        Q J Med. 1983; 52: 382-394
        • Dejaegher P.
        • Demedts M.
        Bronchoalveolar lavage in eosinophilic pneumonia before and during corticosteroid therapy.
        Am Rev Respir Dis. 1984; 129: 631-632
        • De Lassence A.
        • Fleury-Feith J.
        • Escudier E.
        • et al.
        Alveolar hemorrhage: Diagnostic criteria and results in 194 immunocompromised hosts.
        Am J Respir Crit Care Med. 1995; 151: 157-163
        • Devaney K.O.
        • Travis W.D.
        • Hoffman G.S.
        • et al.
        Interpretation of head and neck biopsies in Wegener's granulomatosis. A pathologic study of 126 biopsies in 70 patients.
        Am J Surg Pathol. 1990; 14: 555-564
        • Dietrich P.A.
        • Johnson R.D.
        • Fairbank J.T.
        • et al.
        The chest radiograph in Legionnaires' disease.
        Radiology. 1978; 127: 577-582
        • Domingo C.
        • Roig J.
        • Planas F.
        • et al.
        Radiographic appearance of Legionnaire's disease after erythromycin treatment.
        Thorax. 1991; 46: 663-666
        • duBois R.M.
        • McAllister W.A.C.
        • Branthwaite M.A.
        Alveolar proteinosis: Diagnosis and treatment over a 10-year period.
        Thorax. 1983; 38: 360-363
        • Edelstein P.H.
        Antimicrobial chemotherapy for Legionnaire's disease: A review.
        Clin Infect Dis. 1995; 21: S265-S276
        • El-Ebiary M.
        • Sarmiento X.
        • Torres A.
        • et al.
        Prognostic factors of severe Legionella pneumonia requiring admission to ICU.
        Am J Respir Crit Care Med. 1997; 156: 1467-1472
        • Epler G.R.
        • Colby T.V.
        • McLoud T.C.
        • et al.
        Bronchiolitis obliterans organizing pneumonia.
        N Engl J Med. 1985; 312: 152-158
        • Epstein D.M.
        Bronchioloalveolar carcinoma.
        Semin Roentgenol. 1990; 25: 105-111
        • Erickson R.W.
        • Franklin W.A.
        • Emlen W.
        Treatment of hemorrhagic lupus pneumonitis with plasmapheresis.
        Semin Arthritis Rheum. 1994; 24: 114-123
        • Evans A.F.
        • Oakley R.H.
        • Whitehouse G.H.
        Analysis of the chest radiograph in Legionnaires' disease.
        Clin Radiol. 1981; 32: 361-365
        • Fairbank J.T.
        • Mamourian A.C.
        • Dietrich P.A.
        • et al.
        The chest radiograph in Legionnaires' disease. Further observations.
        Radiology. 1983; 147: 33-34
        • Fairbank J.T.
        • Mayur M.P.
        • Dietrich P.A.
        Legionnaires' disease.
        J Thoracic Imaging. 1991; 6: 6-13
        • Fauci A.S.
        • Haynes B.F.
        • Katz P.
        • et al.
        Wegener's granulomatosis: Prospective clinical and therapeutic experience with 85 patients for 21 years.
        Ann Intern Med. 1983; 98: 76-85
        • Fein A.M.
        • Feinsilver S.H.
        The approach to non-resolving pneumonia in the elderly.
        Semin Respir Infect. 1993; 8: 59-72
        • Fein A.M.
        • Feinsilver S.H.
        • Niederman M.S.
        • et al.
        “When the pneumonia doesn't get better.”.
        Clin Chest Med. 1987; 8: 529-541
        • Fein A.M.
        • Feinsilver S.H.
        • Niederman M.S.
        Non-resolving and slowly resolving pneumonia. Diagnosis and management in the elderly patient.
        Clin Chest Med. 1993; 14: 555-569
        • Feinsilver S.H.
        • Fein A.M.
        • Teitcher J.
        A practical approach to non-resolving pneumonia.
        Semin Respir Infect. 1992; 7: 289-293
        • Feinsilver S.H.
        • Fein A.M.
        • Niederman M.S.
        • et al.
        Utility of fiberoptic bronchoscopy in nonresolving pneumonia.
        Chest. 1990; 98: 1322-1326
        • Fine M.J.
        • Auble T.E.
        • Yealy D.M.
        • et al.
        A prediction rule to identify low risk patients with community-acquired pneumonia.
        N Engl J Med. 1997; 336: 243-250
        • Fine M.J.
        • Smith M.A.
        • Carson C.A.
        • et al.
        Prognosis and outcomes of patients with community-acquired pneumonia: A meta-analysis.
        JAMA. 1995; 274: 134-141
        • Finkelstein M.
        • Petukun W.
        • Freedman M.
        • et al.
        Pneumococcal bacteremia in adults: Age-dependent differences in presentation and outcome.
        J Am Geriatr Soc. 1983; 31: 19-37
        • Finnegan O.C.
        • Fowles S.J.
        • White R.J.
        Radiographic appearances of Mycoplasma pneumonia.
        Thorax. 1981; 36: 469-472
        • Fleury-Feith J.
        • Van Nhieu J.T.
        • Picard C.
        • et al.
        Bronchoalveolar lavage eosinophilia associated with Pneumocystis carinii pneumonitis in AIDS patients. Comparative study with non-AIDS patients.
        Chest. 1989; 95: 1198-1201
        • Fortin P.R.
        • Larson M.G.
        • Watters A.K.
        • et al.
        Prognostic factors in systemic necrotizing vasculitis of the polyarteritis nodosa group—a review of 45 cases.
        J Rheumatol. 1995; 22: 78-84
        • Foy H.M.
        • Clarke E.R.
        • Mansy A.W.
        • et al.
        Radiographic study of Mycoplasma pneumoniae pneumonia.
        Am Rev Respir Dis. 1973; 108: 469-474
        • Fraser D.W.
        • Tsai T.R.
        • Orenstein W.
        • et al.
        Legionnaires' disease. Description of an epidemic of pneumonia.
        N Engl J Med. 1977; 297: 1189-1197
        • Gaensler E.A.
        • Carrington C.B.
        Peripheral opacities in chronic eosinophilic pneumonia: The photographic negative of pulmonary edema.
        AJR Am J Roentgenol. 1977; 128: 1-13
        • Gaudin P.B.
        • Askin F.B.
        • Falk R.J.
        • et al.
        The pathologic spectrum of pulmonary lesions in patients with anti-neutrophil cytoplasmic autoantibodies specific for anti-proteinase 3 and anti-myeloperoxidase.
        Am J Clin Pathol. 1995; 104: 7-16
        • Gertner E.
        • Lie J.T.
        Pulmonary capillaritis, alveolar hemorrhage, and recurrent microvascular thrombosis in primary antiphospholipid syndrome.
        J Rheumatol. 1993; 20: 1224-1228
        • Gibson S.P.
        • Weir D.C.
        • Burge P.S.
        A prospective audit of the value of fiberoptic bronchoscopy in adults admitted with community-acquired pneumonia.
        Respir Med. 1993; 87: 105-109
        • Granados A.
        • Podzamczer D.
        • Guidol F.
        • et al.
        Pneumonia due to Legionella pneumophila and pneumococcal pneumonia: Similarities and differences on presentation.
        Eur Respir J. 1989; 2: 130-134
        • Grayston J.T.
        • Campbell L.A.
        • Kuo C.C.
        • et al.
        A new respiratory tract pathogen: Chlamydia pneumoniae strain, TWAR.
        J Infect Dis. 1990; 161: 618-625
        • Gross T.
        • Chavis A.D.
        • Lynch III, J.P.
        Noninfectious pulmonary diseases masquerading as community-acquired pneumonia.
        Clin Chest Med. 1991; 12: 363-393
        • Guillevin L.
        • Cordier J.F.
        • Lhote F.
        • et al.
        A prospective, multicenter, randomized trial comparing steroids and pulse or oral cyclophosphamide in generalized Wegener's granulomatosis.
        Arthritis Rheum. 1997; 40: 2187-2198
        • Guillevin L.
        • Lhote F.
        • Cohen P.
        • et al.
        Corticosteroids plus pulse cyclophosphamide and plasma exchanges versus corticosteroids plus pulse cyclophosphamide alone in the treatment of polyarteritis nodosa and Churg-Strauss syndrome patients with factors predicting poor prognosis.
        Arthritis Rheum. 1995; 38: 1638-1645
        • Guillevin L.
        • Lhote F.
        • Gayraud M.
        • et al.
        Prognostic factors in polyarteritis nodosa and Churg-Strauss syndrome.
        Medicine (Baltimore). 1996; 75: 17-28
        • Guillevin L.
        • Visser H.
        • Noel L.H.
        • et al.
        Antineutrophil cytoplasm antibodies in systemic polyarteritis nodosa with and without hepatitis B infection and Churg-Strauss syndrome—62 patients.
        J Rheumatol. 1993; 20: 1345-1349
        • Gump D.W.
        • Frank R.O.
        • Winn Jr, W.C.
        • et al.
        Legionnaires' disease in patients with associated serious disease.
        Ann Intern Med. 1979; 90: 538-542
        • Gurney J.W.
        Hypersensitivity pneumonitis.
        Radiol Clin North Am. 1992; 30: 1219-1230
        • Haworth S.J.
        • Savage C.O.
        • Carr D.
        • et al.
        Pulmonary hemorrhage complicating Wegener's granulomatosis and microscopic polyarteritis.
        Br Med J. 1985; 290: 1175-1178
        • Hayakawa H.
        • Sato A.
        • Toyoshima M.
        • et al.
        A clinical study of idiopathic eosinophilic pneumonia.
        Chest. 1994; 105: 1462-1466
        • Hebert D.H.
        The roentgen features of Eaton agent pneumonia.
        AJR Am J Roentgenol. 1966; 98: 300-304
        • Helms C.M.
        • Viner J.P.
        • Strum R.H.
        • et al.
        Comparative features of pneumococcal, mycoplasmal and Legionnaires' disease pneumonias.
        Ann Intern Med. 1979; 90: 543-547
        • Hendin A.S.
        Clearing patterns of pulmonary infarction and slowly resolving pneumonia.
        Radiology. 1975; 114: 557-559
        • Herry I.
        • Cadranel J.
        • Antoine M.
        • et al.
        Cytomegalovirus-induced alveolar hemorrhage in patients with AIDS: A new clinical entity?.
        Clin Infect Dis. 1996; 22: 616-620
        • Hirschmann J.V.
        • Everett E.D.
        Haemophilus influenzae infections in adults: Report of nine cases and a review of the literature.
        Medicine (Baltimore). 1979; 56: 80-94
        • Hoffman R.M.
        • Rogers R.M.
        Serum and lavage lactate dehydrogenase isoenzymes in pulmonary alveolar proteinosis.
        Am Rev Respir Dis. 1989; 139: 1030-1032
        • Hoffman G.S.
        • Specks U.
        Antineutrophil cytoplasmic antibodies.
        Arthritis Rheum. 1998; 41: 1521-1537
        • Hoffman G.S.
        • Kerr G.S.
        • Leavitt R.Y.
        • et al.
        Wegener's granulomatosis: An analysis of 158 patients.
        Ann Intern Med. 1992; 116: 488-498
        • Hoffman G.S.
        • Leavitt R.Y.
        • Fleisher T.A.
        • et al.
        Treatment of Wegener's granulomatosis with intermittent high-dose intravenous cyclophosphamide.
        Am J Med. 1990; 89: 403-410
        • Hogan S.L.
        • Nachman P.H.
        • Wilkman A.S.
        • et al.
        Prognostic markers in patients with antineutrophil cytoplasmic autoantibody-associated microscopic polyangiitis and glomerulonephritis.
        J Am Soc Nephrol. 1996; 7: 23-32
        • Holdsmith S.
        • Boyce N.
        • Thomson N.M.
        • et al.
        The clinical spectrum of acute glomerulnephritis and lung haemorrhage (Goodpasture's syndrome).
        Q J Med. 1985; 216: 75-86
        • Hook III, E.W.
        • Horton C.A.
        • Schaberg D.R.
        Failure of intensive care unit support to influence mortality from pneumococcal bacteremia.
        JAMA. 1983; 249: 1055-1057
        • Hughes-Davies L.
        • Kocjan G.
        • Spittle M.F.
        • et al.
        Occult alveolar haemorrhage in bronchopulmonary Kaposi's sarcoma.
        J Clin Pathol. 1992; 45: 536-537
        • Israel H.L.
        • Weiss W.
        • Eisenberg G.M.
        • et al.
        Delayed resolution of pneumonia.
        Med Clin North Am. 1956; 40: 1291-1303
        • Izumi T.
        • Kitaichi M.
        • Nishimura K.
        • et al.
        Bronchiolitis obliterans organizing pneumonia. Clinical features and differential diagnosis.
        Chest. 1992; 102: 715-719
        • Jannson E.
        • Wager O.
        • Stenstrom R.
        • et al.
        Studies on Eaton PPLO pneumonia.
        Br Med J. 1964; 1: 142-145
        • Jay S.J.
        • Johanson Jr, W.G.
        • Pierce A.K.
        The radiographic resolution of Streptococcus pneumoniae pneumonia.
        N Engl J Med. 1975; 293: 798-780
        • Jeannette J.C.
        • Falk R.J.
        • Andrassy K.
        • et al.
        Nomenclature of systemic vasculitides. Proposal of an International Consensus Conference.
        Arthritis Rheum. 1994; 37: 187-192
        • Jederlinic P.J.
        • Sicilian L.
        • Gaensler E.A.
        Chronic eosinophilic pneumonia. A report of 19 cases and a review of the literature.
        Medicine (Baltimore). 1988; 67: 154-162
        • Johnson J.P.
        • Moore J.
        • Austin A.A.
        • et al.
        Therapy of anti-glomerular basement membrane antibody disease: Analysis of prognostic significance of clinical, pathologic, and treatment factors.
        Medicine (Baltimore). 1985; 64: 219-227
        • Kauppinen M.T.
        • Saikku P.
        Pneumonia due to Chlamydia pneumoniae: Prevalence, clinical features, diagnosis, and treatment.
        Clin Infect Dis. 1995; 21: S244-S252
        • Kauppinen M.T.
        • Lahde S.
        • Syrjala H.
        Roentgenographic findings of pneumonia caused by Chlamydia pneumoniae. A comparison with Streptococcus pneumonia.
        Arch Intern Med. 1996; 156: 1851-1856
        • Kauppinen M.T.
        • Saikku P.
        • Kujala P.
        • et al.
        Chlamydia pneumoniae pneumonia requiring hospital treatment: A comparison between chlamydial and pneumococcal pneumonia.
        Thorax. 1996; 51: 185-189
        • Kelly P.T.
        • Haponik E.F.
        Goodpasture syndrome: Molecular and clinical advances.
        Medicine (Baltimore). 1994; 73: 171-185
        • Kerr G.
        • Fleisher T.A.
        • Hallahan C.W.
        • et al.
        Limited prognostic value of changes in anti-neutrophil cytoplasmic antibody titer in patients with Wegener's granulomatosis.
        Arthritis Rheum. 1993; 36: 365-371
        • Kingston J.R.
        • Chanock R.M.
        • Mufson M.A.
        • et al.
        Eaton agent pneumonia.
        JAMA. 1961; 176: 118-123
        • Kirby B.D.
        • Peck H.
        • Meyer R.D.
        Radiographic features of Legionnaires' disease Chest. 1979; 76: 562-565
        • Kirtland S.H.
        • Winterbauer R.H.
        Slowly resolving, chronic and recurrent pneumonia.
        Clin Chest Med. 1991; 12: 303-318
        • Kokkarinen J.
        Effect of corticosteroid treatment on the recovery of pulmonary function in farmer's lung.
        Am Rev Respir Dis. 1992; 145: 3-5
        • Kokkarinen J.
        • Tukiainen H.
        • Terho E.O.
        Recovery of pulmonary function in farmer's lung-a 5-year follow-up study.
        Am Rev Respir Dis. 1993; 147: 793-796
        • Kokkarinen J.
        • Tukiainen H.
        • Terho E.O.
        Mortality due to farmer's lung in Finland.
        Chest. 1994; 106: 509-512
        • Koss M.
        • Hochholzer L.
        • Nichols P.W.
        • et al.
        A primary non-Hodgkin's lymphoma and pseudolymphoma of the lung. A study of 161 patients.
        Hum Pathol. 1983; 14: 1024-1038
        • Kroboth F.J.
        • Yu V.L.
        • Reddy S.C.
        • et al.
        Clinicoradiographic correlation with the extent of Legionnaires' disease.
        AJR. 1983; 141: 263-268
        • Lacasse Y.
        • Fraser R.S.
        • Fournier M.
        • et al.
        Diagnostic accuracy of transbronchial lung biopsy in acute farmer's lung disease.
        Chest. 1997; 112: 459-465
        • Lalancette M.
        • Carrier G.
        • Laviolette M.
        • et al.
        Farmer's lung. Long-term outcome and lack of predictive value of bronchoalveolar lavage fibrosing factors.
        Am Rev Respir Dis. 1993; 148: 216-221
        • Langford C.A.
        • Sneller M.C.
        • Hallahan C.W.
        • et al.
        Clinical features and therapeutic management of subglottic stenosis in patients with Wegener's granulomatosis.
        Arthritis Rheum. 1996; 39: 1754-1760
        • Lanham J.G.
        • Elkon K.B.
        • Pusey C.D.
        • et al.
        Systemic vasculitis with asthma and eosinophilia: A clinical approach to the Churg-Strauss Syndrome.
        Medicine (Baltimore). 1984; 63: 65-81
        • Leatherman J.
        Autoimmune diffuse alveolar hemorrhage.
        Clinical Pulmonary Medicine. 1994; 1: 356-364
        • Leatherman J.W.
        • Davies S.F.
        • Hoidal J.R.
        Alveolar hemorrhage syndromes. Diffuse microvascular lung hemorrhage in immune and idiopathic disorders.
        Medicine (Baltimore). 1984; 63: 343-361
        • Lechleither P.
        • Defregger M.
        • Lhotta K.
        • et al.
        Goodpasture's syndrome: Unusual presentation after exposure to hard metal dust.
        Chest. 1993; 103: 956-957
        • Lee K.S.
        • Kullnig P.
        • Harman T.E.
        • et al.
        Cryptogenic organizing pneumonia: CT findings in 43 patients.
        AJR Am J Roentgenol. 1994; 162: 543-546
        • Le Thi Huong D.
        • Papo T.
        • Piette J.C.
        • et al.
        Monthly intravenous pulse cyclophosphamide therapy in Wegener's granulomatosis.
        Clin Exp Rheumatol. 1996; 14: 9-16
        • Levin D.
        • Schwarz M.
        • Matthay R.
        • et al.
        Bacteremic Haemophilus influenzae pneumonia in adults.
        Am J Med. 1977; 62: 219-222
        • Levy M.
        • Dromer F.
        • Brion N.
        • et al.
        Community-acquired pneumonia. Importance of initial noninvasive bacteriologic and radiographic investigations.
        Chest. 1988; 92: 43-48
        • Lhote F.
        • Guillevin L.
        Polyarteritis nodosa, microscopic polyangiitis, and Churg-Strauss Syndrome.
        Semin Respir Crit Care Med. 1998; 19: 27-46
        • Libby D.M.
        • Murphy T.F.
        • Edwards A.
        • et al.
        Chronic eosinophilic pneumonia: An unusual cause of acute respiratory failure.
        Am Rev Respir Dis. 1980; 122: 497-500
        • Lieberman D.
        • Lieberman D.
        Atypical pathogen pneumonia.
        Curr Opin Pulmonol Med. 1997; 3: 111-115
        • Lieberman D.
        • Ben-Yaakov M.
        • Lazarovich Z.
        • et al.
        Chlamydia pneumoniae community-acquired pneumonia: A review of 62 hospitalized patients.
        Infect. 1995; 24: 109-114
        • Lieberman D.
        • Porath A.
        • Schlaeffer F.
        • et al.
        Legionella sp community-acquired pneumonia: A review of 56 hospitalized patients.
        Chest. 1995; 109: 1243-1249
        • Lieberman D.
        • Schlaeffer F.
        • Boldur I.
        • et al.
        Multiple pathogens in adult patients admitted with community-acquired pneumonia: A 1-year prospective study of 346 consecutive patients.
        Thorax. 1996; 51: 179-184
        • Lieberman D.
        • Schlaeffer F.
        • Lieberman D.
        • et al.
        Mycoplasma pneumoniae community-acquired pneumonia: A review of 101 hospitalized adult patients.
        Respiration. 1996; 63: 261-266
        • Lombard C.M.
        • Colby T.V.
        • Elliott C.G.
        Surgical pathology of the lung in anti-basement membrane antibody-associated Goodpasture's syndrome.
        Hum Pathol. 1989; 20: 445-451
        • Lombard C.M.
        • Duncan S.R.
        • Rizk N.W.
        • et al.
        The diagnosis of Wegener's granulomatosis from transbronchial lung biopsy specimens.
        Hum Pathol. 1990; 21: 838-842
        • Lombard C.M.
        • Tazelaar H.D.
        • Krasne D.L.
        Pulmonary eosinophilia in coccidioidal infections.
        Chest. 1987; 91: 734-736
        • Luby J.P.
        Pneumonia caused by Mycoplasma pneumoniae infection.
        Clin Chest Med. 1991; 12: 237-244
        • Luquami R.A.
        • Bacon P.A.
        • Beaman M.
        • et al.
        Classical versus non-renal Wegener's granulomatosis.
        QJM. 1994; 87: 161-167
        • Lynch D.A.
        • Newell J.D.
        • Logan P.M.
        • et al.
        Can CT distinguish hypersensitivity pneumonitis from idiopathic pulmonary fibrosis?.
        AJR Am J Reontgenol. 1995; 165: 807-811
        • Lynch J.P.
        • Sitrin R.G.
        Noninfectious mimics of community-acquired pneumonia.
        Semin Respir Infect. 1993; 8: 14-45
        • Lynch III, J.P.
        • Hoffman G.S.
        Wegener's granulomatosis: Controversies and current concepts.
        Compr Ther. 1998; 24: 421-440
        • Lynch III, J.P.
        • Leatherman J.W.
        Alveolar hemorrhage syndromes.
        in: Fishman A.P. Fishman's Pulmonary Diseases and Disorders. ed 3. McGraw Hill, New York1998: 1193-1210
        • Lynch III, J.P.
        • Martinez F.J.
        Community-acquired pneumonia.
        Curr Opin Pulm Med. 1998; 4: 162-172
        • Lynch III, J.P.
        • McCune W.J.
        Immunosuppressive and cytotoxic pharmacotherapy for pulmonary disorders: State of the art.
        Am J Respir Crit Care Med. 1997; 155: 395-420
        • Lynch III, J.P.
        • Raghu G.
        Major disease syndromes of unknown etiology.
        in: Baum G.L. Crapo J.D. Celli B.R. Textbook of Pulmonary Diseases. ed 6. Lippincott-Raven Publishers, Philadelphia1998: 431-476
        • Macdowell D.E.
        • Clarksburg W.V.
        Bronchoscopic detection of bronchogenic carcinoma in cases of pneumonia.
        South Med J. 1980; 73: 761-762
        • Macfarlane J.T.
        • Miller A.C.
        • Roderick Smith W.H.
        • et al.
        Comparative radiographic features of community-acquired Legionnaires' desease, pneumococcal pneumonia, Mycoplasma pneumonia, and psittacosis.
        Thorax. 1984; 39: 28-33
        • Marchand E.
        • Reynaud-Gaubert M.
        • Lauque D.
        • et al.
        Idiopathic chronic eosinophilic pneumonia: A clinical and follow-up study of 62 cases.
        Medicine (Baltimore). 1998; 77: 299-312
        • Marrie T.J.
        Community-acquired pneumonia.
        Clin Infect Dis. 1994; 18: 501-515
        • Marrie T.J.
        • Peeling R.W.
        • Fine M.J.
        • et al.
        Ambulatory patients with community-acquired pneumonia: The frequency of atypical agents and clinical course.
        Am J Med. 1996; 101: 508-515
        • Marston B.J.
        • Lipman H.B.
        • Breiman R.F.
        Surveillance for Legionnaire's disease: Risk factors for morbidity and mortality.
        Arch Intern Med. 1994; 154: 2417-2422
        • Marston B.J.
        • Plouffe J.F.
        • File T.M.
        • et al.
        Incidence of community-acquired pneumonia requiring hospitalization: Results of a population-based active surveillance study in Ohio.
        Arch Intern Med. 1997; 157: 1709-1718
        • Martin II, W.J.
        Amiodarone pulmonary toxicity. Recognition and pathogenesis.
        Chest. 1988; 93 (1242–1248): 1067-1075
        • Martinez F.
        • Lynch III, J.P.
        Collagen vascular disease-associated bronchiolitis obilterans organizing pneumonia.
        in: Epler G.R. Diseases of the Bronchioles. Raven Press, New York1994: 347-366
        • Martinez-Lopez M.A.
        • Gomez-Cerezo G.
        • Villasante C.
        • et al.
        Pulmonary alveolar proteinosis: Prolonged spontaneous remission in two patients.
        Eur Respir J. 1991; 4: 377-379
        • Masi A.T.
        • Hunder G.G.
        • Lie J.T.
        • et al.
        The American College of Rheumatology 1990 criteria in the classification of Churg-Strauss syndrome (allergic granulomatosis and angiitis).
        Arthritis Rheum. 1990; 33: 1094-1100
        • Mayo J.R.
        • Muller N.L.
        • Road J.
        • et al.
        Chronic eosinophilic pneumonia. CT findings in six cases.
        AJR Am J Roentgenol. 1989; 153: 727-730
        • McConnell Jr, C.T.
        • Plouffe J.F.
        • File T.M.
        • et al.
        Radiographic appearance of Chlamydia pneumoniae (TWAR strain) respiratory infections.
        Radiology. 1994; 192: 819-824
        • Meeker D.P.
        • Gephardt G.N.
        • Cordasco E.M.
        • et al.
        Hypersensitivity pneumonitis verus invasive pulmonary aspergillosis: Two cases with unusual pathologic findings and review of the literature.
        Am Rev Respir Dis. 1991; 143: 431-436
        • Metcalf J.P.
        • Rennard S.I.
        • Reed E.C.
        • et al.
        Corticosteroids as adjunctive therapy for diffuse alveolar hemorrhage associated with bone marrow transplantation.
        Am J Med. 1994; 96: 327-334
        • Miller A.C.
        Early clinical differentiation between Legionnaire's disease and other sporadic pneumonias.
        Ann Intern Med. 1979; 90: 526-528
        • Miller A.C.
        • Pearson S.B.
        • Roderick Smith W.H.
        Legionnaires' disease: Radiological resolution and bronchoscopy [letter].
        Lancet. 1978; 2: 570
        • Mittl Jr, R.L.
        • Schwab R.J.
        • Duchin J.S.
        • et al.
        Radiographic resolution of community-acquired pneumonia.
        Am J Respir Crit Care Med. 1994; 149: 630-635
        • Moore E.H.
        • Webb W.R.
        • Gamsu G.
        • et al.
        Legionnaires' disease in the renal transplant patient: Clinical presentation and radiographic progression.
        Radiology. 1984; 153: 589-593
        • Muder R.R.
        • Reddy S.C.
        • Yu V.L.
        • et al.
        Pneumonia caused by Pittsburgh pneumonia agent: Radiologic manifestations.
        Radiology. 1984; 150: 633-637
        • Muder R.R.
        • Yu V.L.
        • Parry M.F.
        The radiographic manifestations of Legionella pneumonia.
        Semin Respir Infect. 1987; 2: 242-254
        • Muder R.R.
        • Yu V.L.
        • Zuravlett J.J.
        Pneumonia due to the Pittsburgh pneumonia agent: New clinical perspective with a review of the literature.
        Medicine (Baltimore). 1983; 62: 120-128
        • Mufson M.A.
        • Kruss D.M.
        • Wasil R.E.
        • et al.
        Capsular types and oucome of bacteremic pneumococcal disease in the antibiotic era.
        Arch Intern Med. 1974; 134: 505-510
        • Mulder P.O.M.
        • Meinesz A.
        • DeVries E.G.E.
        • et al.
        Diffuse alveolar hemorrhage in autologous bone marrow transplant recipients.
        Am J Med. 1991; 90: 278-280
        • Muller N.L.
        • Miller R.R.
        Diseases of the bronchioles: CT and histopathologic findings.
        Radiology. 1995; 196: 3-12
        • Mundy L.M.
        • Auwaerter P.G.
        • Oldach D.
        • et al.
        Community-acquired pneumonia: Impact of immune status.
        Am J Respir Crit Care Med. 1995; 152: 1309-1315
        • Murayama J.
        • Toshizawa Y.
        • Ohtsuka M.
        • et al.
        Lung fibrosis in hypersensitivity pneumonitis: Association with CD4+ but not CD8+ dominant alveolitis and insidious onset.
        Chest. 1993; 104: 38-43
        • Musher D.
        • Kubitschek K.
        • Crennan J.
        • et al.
        Pneumonia and acute febrile tracheobronchitis due to Haemophilus influenzae..
        Ann Intern Med. 1983; 99: 444-450
        • Myers J.L.
        • Colby T.V.
        Pathological manifestations of bronchiolitis, constrictive bronchiolitis, cryptogenic organizing pneumonia, and diffuse panbronchiolitis.
        Clin Chest Med. 1993; 14: 611-622
        • Myers J.L.
        • Katzenstein A.A.
        Microangiitis in lupus-induced pulmonary hemorrhage.
        Am J Clin Pathol. 1985; 85: 552-556
        • Myers J.L.
        • Kurtin P.J.
        Lymphoid proliferative disorders of the lung.
        in: Thurlbeck W.M. Churg A.M. Pathology of the Lung. ed 2. Thieme Medical Publishers, New York1995: 553-588
        • Naughton M.
        • Fahy J.
        • Fitzgerald M.X.
        Chronic eosinophilic pneumonia. A long-term follow-up of 12 patients.
        Chest. 1993; 103: 162-165
        • Neill A.M.
        • Martin I.R.
        • Weir R.
        • et al.
        Community-acquired pneumonia: Aetiology and usefulness of severity criteria on admission.
        Thorax. 1996; 51: 1010-1016
        • Niederman M.S.
        • Bass Jr, J.B.
        • Campbell G.D.
        • et al.
        Guidelines for the initial management of adults with community-acquired pneumonia: Diagnosis, assessment of severity, and initial antimicrobial therapy.
        Am Rev Respir Dis. 1993; 148: 1418-1426
        • Nishino H.
        • Rubino F.A.
        • DeRemee R.A.
        • et al.
        Neurological involvement in Wegener's granulomatosis: An analysis of 324 consecutive patients at the Mayo Clinic.
        Ann Neurol. 1993; 33: 4-90
        • Ogawa H.
        • Fujimura M.
        • Matsuda T.
        • et al.
        Transient wheeze. Eosinophilic bronchobronchiolitis in acute eosinophilic pneumonia.
        Chest. 1993; 104: 493-496
        • Orens J.
        • Martinez F.J.
        • Lynch III, J.P.
        Pulmonary manifestations of systemic lupus erythematosus.
        Rheum Dis Clin N Am. 1994; 20: 159-193
        • Orens J.B.
        • Sitrin R.G.
        • Lynch III, J.P.
        The approach to non-resolving pneumonia.
        Med Clin North Am. 1994; 78: 1143-1171
        • Ortqvist A.
        • Kalin M.
        • Lejdeborn L.
        • et al.
        Diagnostic fiberoptic bronchoscopy and protected brush culture in patients with community-acquired pneumonia.
        Chest. 1990; 97: 576-582
        • Pallares R.
        • Linares J.
        • Vadillo M.
        • et al.
        Resistance to penicillin and cephalosporin and mortality from severe pneumococcal pneumonia in Barcelona, Spain.
        N Engl J Med. 1995; 333: 481-486
        • Patterson R.
        • Nugent K.M.
        • Harris K.E.
        • et al.
        Immunologic hemorrhagic pneumonia caused by isocyanates.
        Am Rev Respir Dis. 1990; 141: 226-230
        • Pedro-Botet M.L.
        • Sbria-Leal M.
        • Haro M.
        • et al.
        Nosocomial and community-acquired Legionella pneumoniae: Clinical comparative analysis.
        Eur Respir J. 1995; 8: 1929-1933
        • Perez-Padilla R.
        • Salas J.
        • Chapela R.
        Mortality in Mexican patients with chronic pigeon breeders lung compared with those with usual interstitial pneumonia.
        Am Rev Respir Dis. 1993; 148: 49-53
        • Persson A.
        Pulmonary alveolar proteinosis.
        in: Fishman's Pulmonary Diseases and Disorders. ed 3. McGraw Hill, New York1998: 1224-1230
        • Pittet D.
        • Huguenin T.
        • Dharan S.
        • et al.
        Unusual cause of lethal pulmonary aspergillosis in patients with chronic obstructive pulmonary disease.
        Am J Respir Crit Care Med. 1996; 154: 541-544
        • Prakash U.B.
        • Barham S.S.
        • Carpenter H.A.
        • et al.
        Pulmonary alveolar phospholipoproteinosis: Experience with 34 cases and a review.
        Mayo Clin Proc. 1987; 62: 499-518
        • Primack S.L.
        • Miller R.R.
        • Muller N.L.
        Diffuse pulmonary hemorrhage: Clinical, pathologic, and imaging features.
        Am J Roentgenol. 1995; 164: 295-300
        • Purcell I.F.
        • Bourke S.J.
        • Marshall S.M.
        Cyclophosphamide in severe steroid-resistant bronchiolitis obliterans organizing pneumonia.
        Respir Med. 1997; 91: 175-177
        • Pusey C.D.
        • Rees A.J.
        • Evans D.J.
        • et al.
        Plasma exchange in focal necrotizing glomerulonephritis without anti-GBM antibodies.
        Kidney Int. 1991; 40: 757-763
        • Putman C.E.
        • Curtis A.
        • et al.
        Mycoplasma pneumonia. Clinical and roentgenographic patterns.
        AJM Am J Roentgenol. 1975; 124: 417-422
        • Quinones C.A.
        • Memon M.A.
        • Sarosi G.A.
        Bacteremic Hemophilus influenzae pneumonia in the adult.
        Semin Respir Infec. 1989; 4: 12-18
        • Rahav G.
        • Toledano Y.
        • Engelhard D.
        • et al.
        Invasive pneumococcal infections: A comparison between adults and children.
        Medicine (Baltimore). 1997; 76: 295-303
        • Ramirez-Venegas A.
        • Sansores R.H.
        • Perez-Padilla R.
        • et al.
        Utility of a provocation test for diagnosis of chronic pigeon breeder's disease.
        Am J Respir Crit Care Med. 1998; 158: 862-869
        • Rao J.K.
        • Weinberger M.
        • Oddone E.Z.
        • et al.
        The role of antineutrophil cytoplasmic antibody (c-ANCA) testing in the diagnosis of Wegener granulomatosis. A literature review and meta-analysis.
        Ann Intern Med. 1995; 123: 925-932
        • Reinhold-Keller E.
        • de Grott K.
        • Rudert H.
        • et al.
        Response to trimethoprim/sulfamethoxazole in Wegener's granulomatosis depends on the phase of disease.
        QJM. 1996; 89: 15-23
        • Reinhold-Keller E.
        • Kekow J.
        • Schnabel A.
        • et al.
        Influence of disease manifestation and antineutrophil-cytoplasmic antibody titer on the response to pulse cyclophosphamide therapy in patients with Wegener's granulomatosis.
        Arthritis Rheum. 1994; 37: 919-924
        • Ricker D.H.
        • Taylor S.R.
        • Gartner Jr, J.C.
        • et al.
        Fatal pulmonary aspergillosis presented as acute eosinophilic pneumonia in a previously healthy child.
        Chest. 1991; 100: 875-877
        • Riquelme R.
        • Torres A.
        • El-Ebiary M.
        • et al.
        Community-acquired pneumonia in the elderly: A multivariate analysis of risk and prognostic factors.
        Am J Respir Crit Care Med. 1996; 154: 1450-1455
        • Rodrigues J.
        • Niederman M.S.
        • Fein A.M.
        • et al.
        Non-resolving pneumonia in steroid-treated patients with obstructive lung diseases.
        Am J Med. 1992; 93: 29-34
        • Rohatgi P.K.
        • Smirniotopoulos T.T.
        Tropical eosinophilia.
        Semin Respir Med. 1991; 12: 98-106
        • Rosenow III, E.C.
        • Limper A.H.
        Drug-induced pulmonary disease.
        Semin Respir Infect. 1995; 10: 86-95
        • Saikku P.
        • Wang P.
        • Kleemola M.
        • et al.
        An epidemic of mild pneumonia due to an unusual strain of Chlamydia psittaci..
        J Infect Dis. 1985; 151: 832-839
        • Saralovatz L.D.
        • Burch K.H.
        • Fischer E.
        • et al.
        The compromised host and Legionnaires' disease.
        Ann Intern Med. 1979; 90: 533-537
        • Savage C.O.S.
        • Winearls C.G.
        • Evans D.J.
        • et al.
        Microscopic polyarteritis: Presentation, pathology, and prognosis.
        QJM. 1985; 56: 467-483
        • Saxena R.
        • Bygren P.
        • Arvaston B.
        • et al.
        Circulating autoantibodies as serological markers in the differential diagnosis of pulmonary renal syndrome.
        J Intern Med. 1995; 238: 143-152
        • Schneider R.F.
        Lymphocytic interstitial pneumonitis and nonspecific interstitial pneumonitis.
        Clin Chest Med. 1996; 17: 763-766
        • Schwarz M.I.
        • Sutarik J.M.
        • Nick J.A.
        • et al.
        Pulmonary capillaritis and diffuse alveolar hemorrhage: A primary manifestation of polymyositis.
        Am J Respir Crit Care Med. 1995; 151: 2037-2040
        • Selman M.
        • Chapela R.
        • Raghu G.
        Hypersensitivity pneumonitis: Clinical manifestations, diagnosis, pathogenesis, and therapeutic strategies.
        Semin Respir Med. 1993; 14: 353-364
        • Shannon J.
        • Lynch III, J.P.
        Eosinophilic pulmonary syndromes.
        Clin Pulmonol Med. 1995; 2: 19-38
        • Sharma O.P.
        • Fujimura N.
        Hypersensitivity pneumonitis: A noninfectious granulomatosis.
        Semin Respir Infect. 1995; 10: 96-106
        • Shulman S.T.
        • Bartlett J.
        • Clyde W.A.
        • et al.
        The unusual severity of Mycoplasma pneumonia in children with sickle cell disease.
        N Engl J Med. 1972; 287: 164-167
        • Slungaard A.
        • Ascensao J.
        • Zanjani E.
        • et al.
        Pulmonary carcinoma with eosinophilia: Demonstration of a tumor-derived eosinophilopoietic factor.
        N Engl J Med. 1983; 309: 778-781
        • Smith G.J.W.
        The histopathology of pulmonary reactions to drugs.
        Clin Chest Med. 1990; 11: 95-117
        • Sneller M.C.
        • Hoffman G.S.
        • Talar-Williams C.
        • et al.
        An analysis of 42 Wegener's granulomatosis patients treated with methotrexate and prednisone.
        Arthritis Rheum. 1995; 38: 608-613
        • Srivastava A.
        • Gottlieb D.
        • Bradstock K.F.
        Diffuse alveolar hemorrhage associated with microangiopathy after allogeneic bone marrow transplantation.
        Bone Marrow Transplant. 1995; 15: 863-867
        • Stead W.W.
        • Lofgren J.P.
        • Warren E.
        • et al.
        Tuberculosis as an endemic and nosocomial infection among the elderly in nursing homes.
        N Engl J Med. 1985; 312: 1483-1487
        • Stegeman C.A.
        • Cohen Tervaert J.W.
        • de Johng P.E.
        • et al.
        Trimethoprim/sulfamethoxazole (co-trimoxazole) for the prevention of relapses in Wegener's granulomatosis.
        N Engl J Med. 1996; 335: 16-20
        • Steinfeld S.
        • Golstein M.
        • DeVuyst P.
        Chronic eosinophilic pneumonia (CEP) as a presenting feature of Churg-Strauss syndrome (CSS).
        Eur Respir J. 1994; 7: 2098
        • Stenstrom R.
        • Jannson E.
        • von Essen R.
        Mycoplasma pneumonias.
        Acta Radiol Diag. 1972; 12: 833-841
        • Stenstrom R.
        • Jannson E.
        • Wager O.
        Ornithosis pneumonia with special reference to roentgenological findings.
        Acta Med Scand. 1962; 171: 349-356
        • Storch G.A.
        • Sagel S.S.
        • Baine W.B.
        The chest roentgenogram in sporadic cases of Legionnaires' disease.
        JAMA. 1981; 245: 587-590
        • Stout J.E.
        • Yu V.L.
        Legionellosis.
        N Engl J Med. 1997; 337: 682-686
        • Straus W.L.
        • Plouffe J.F.
        • File Jr, T.M.
        • et al.
        Risk factors for domestic acquisition of Legionnaire's disease.
        Arch Intern Med. 1996; 156: 1685-1692
        • Sullivan E.J.
        • Hoffman G.S.
        Wegener's granulomatosis.
        Semin Respir Crit Care Med. 1998; 19: 13-25
        • Talar-Williams C.
        • Hijazi Y.M.
        • Walther M.M.
        • et al.
        Cyclophosphamide-induced cystitis and bladder cancer in patients with Wegener's granulomatosis.
        Ann Intern Med. 1996; 124: 477-484
        • Taylor R.J.
        • Schwentker F.N.
        • Hakala T.R.
        Opportunistic lung infections in renal transplant patients: A comparison of Pittsburgh pneumonia agent and Legionnaires' disease.
        J Urol. 1981; 125: 289-292
        • Tazelaar H.D.
        • Linz L.J.
        • Colby T.V.
        • et al.
        Acute eosinophilic pneumonia: Histopathologic findings in nine patients.
        Am J Respir Crit Care Med. 1997; 155: 296-302
        • Thom D.H.
        • Grayston J.T.
        Infections with Chlamydia pneumoniae strain TWAR.
        Clin Chest Med. 1991; 12: 245-256
        • Torres A.
        • Dorca J.
        • Xalacajn R.
        • et al.
        Community-acquired pneumonia in chronic obstructive pulmonary disease: A Spanish multicenter study.
        Am J Respir Crit Care Med. 1996; 154: 1456-1461
        • Torres A.
        • Serra-Batlles J.
        • Ferrer A.
        • et al.
        Severe community-acquired pneumonia: Epidemiologic and prognostic factors.
        Am Rev Respir Dis. 1991; 144: 312-318
        • Travis W.D.
        • Colby T.V.
        • Lombard C.
        • et al.
        A clinicopathologic study of 34 cases of diffuse pulmonary hemorrhage with lung biopsy confirmation.
        Am J Surg Pathol. 1990; 14: 1112-1125
        • Travis W.D.
        • Fox C.H.
        • Devaney K.O.
        Lymphoid interstitial pneumonitis in 50 adult patients infected with the immunodeficiency virus: Lymphocytic interstitial pneumonitis versus nonspecific interstitial pneumonitis.
        Hum Pathol. 1992; 23: 529-541
        • Travis W.D.
        • Hoffman G.S.
        • Leavitt R.Y.
        • et al.
        Surgical pathology of the lung in Wegener's granulomatosis. Review of 87 open lung biopsies from 67 patients.
        Am J Surg Pathol. 1991; 15: 315-333
        • Troy C.J.
        • Peeling R.W.
        • Ellis A.G.
        • et al.
        Chlamydia pneumoniae as a new source of infectious outbreaks in nursing homes.
        JAMA. 1997; 277: 1214-1218
        • Van Metre Jr, T.E.
        Pneumococcal pneumonia treated with antibiotics. The prognostic significance of certain clinical findings.
        N Engl J Med. 1954; 251: 1048-1952
        • Wallace Jr, R.J.
        • Musher D.M.
        • Martin R.R.
        Haemophilus influenzae pneumonia in adults.
        Am J Med. 1978; 64: 87-92
        • Watanakunakorn C.
        • Bailey T.A.
        Adult bacteremic pneumococcal pneumonia in a community teaching hospital, 1992–1996. A detailed analysis of 108 cases.
        Arch Intern Med. 1997; 157: 1965-1971
        • Watanakunakorn C.
        • Greifenstein A.
        • Stroh K.
        • et al.
        Pneumococcal bacteremia in three community teaching hospitals from 1980 to 1989.
        Chest. 1993; 103: 1152-1156
        • Watts R.A.
        • Carruthers D.M.
        • Scott D.G.
        Epidemiology of systemic vasculitis: Changing incidence or definition?.
        Semin Arthritis Rheum. 1995; 25: 28-34
        • Witty L.A.
        • Tapson V.F.
        • Piantadosi C.A.
        Isolation of Mycobacteria in patients with pulmonary alveolar proteinosis.
        Medicine (Baltimore). 1994; 73: 103-109
        • Woodhead M.A.
        • MacFarlane J.T.
        Comparative clinical and laboratory features of Legionella with pneumococcal and mycoplasma pneumonia.
        Br J Dis Chest. 1987; 81: 133-139
        • Yamamoto M.
        • Iny Y.
        • Kitaichi M.
        • et al.
        Clinical features of BOOP in Japan.
        Chest. 1992; 102: 21S-25S
        • Yoshida K.
        • Shijubo N.
        • Koba H.
        • et al.
        Chronic eosinophilic pneumonia progressing to lung fibrosis.
        Eur Respir J. 1994; 7: 1541-1544
        • Yoshida K.
        • Suga M.
        • Nishiura Y.
        • et al.
        Occupational hypersensitivity pneumonitis in Japan: Data on a nationwide epidemiological study.
        Occup Environ Med. 1995; 52: 570-574
        • Zamora M.R.
        • Warner M.I.
        • Tuder R.
        • et al.
        Diffuse alveolar hemorrhage and systemic lupus erythematosus.
        Medicine (Baltimore). 1997; 76: 192-202
        • Zeiss C.R.
        • Wolkonsky P.
        • Chacon R.
        • et al.
        Syndromes in workers exposed to trimellitic anhydride.
        Ann Intern Med. 1983; 98: 8-12