Pathology report is in

dr nichols says he's only seen about 3 or 4 cases like Isaac in his entire career. i think he's around 50 years old?

here's the final diagnosis as made by claire langston at Baylor's down in Texas.

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Lung, right middle and right lower lobes, wedge biopsies:
1. mild lymphocytic bronchiolitis
2. increased alveolar macrophages
3. mildly increased neuroendocrine cells in airways and mildly enlarged neuroepethelial bodies

There is no evidence of residual pneumocystis organisms. There is a very mild lymphocytic bronchiolitis without prominant structural airway changes. This could reflect resolving airway infection or possibly a subtle immune abnormality (note: supposedly leland fan disagreed with this point). The neuroendocrine cells are mildly increased in airways and neuroepithelial bodies are mildly enlarged, but the number of immunopositive cells and the pattern of immunopositivity is not that seen in neuroendocrine hyperplasia of infancy. We have seen a similar distribution of neuroendocrine cells in children recovering from viral infection and in a few children with mild chronic airway disease who have poorly defined immunologic abnormalities. The presence of increased alveolar macrophages suggests increased lung fluid and/or poor clearance secondary to proximal airway disease. Dr. Megan Dishop has also reviewed this case and agrees with the findings.

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dr. nichols says isaac seems to exhibit mild symptoms of both an interstitial pneumonitis (the presence of excess lymphocytes and macrophages) and of persistent tachypnea of infancy (the presence of the neuroendocrine cells).

as far as treatment goes, it would seem that both dr. nichols and dr. fan are on the fence about giving isaac steroids. because his case is mild. so it is possible if that isaac gains significant weight -- he has been eating quite well as of late -- and his oxygen saturation continues to stay high that maybe he will just heal on his own. and that maybe by the time he was 5 years old or before everything would be cleared up.