The aim of this study was to determine the relationship between the radiological pattern of Mycoplasma pneumoniae and the level of cell-mediated immunity of the host.Computed tomographic (CT) scans of the chest and the results of the purified protein derivative (PPD) test were studied during the acute stage of infection in 54 patients with M. pneumoniae pneumonia. The CT findings were used to divide the patients into two groups: one group had a predominance of nodular opacities with a centrilobular distribution (Group N; n=29); and the other showed a predominance of an airspace consolidation (Group C; n=25).Forty out of 54 subjects had negative tuberculin skin tests (<10 mm induration). The positive rate of PPD reaction was higher in Group N (13 out of 29) compared to Group C (1 out of 25) (p=0.0005); whilst pleural effusion appeared more frequently in Group C (10 out of 25) than in Group N (3 out of 29) (p=0.023). There was no significant difference between Groups N and C in white blood cell and lymphocyte counts, level of antibodies to M. pneumoniae in sera, and severity of the disease.These findings suggest that the characteristics of the host cell-mediated immunity might influence the pattern of pulmonary lesions in M. pneumoniae infection. Eur Respir J., 1996, 9, 669-672. The cell-mediated immunity (CMI) of the host plays an important role in the development of Mycoplasma pneumoniae pneumonia (MP) [1,2]. MIZUTANI et al. [3] reported that the delayed hypersensitivity skin reactions to M. pneumoniae antigen appeared to correlate with severity of pneumonia in human MP. FOY et al. [4] reported that MP infection in patients with immunodeficiency syndrome had a lack of radiological chest findings. PUTMAN et al. [5] reported a bilateral reticulonodular pattern when MP was associated with sarcoidosis. These manifestations suggest that pulmonary infiltrates of MP might be a result of the immunological reaction of the host.The purified protein derivative (PPD) reaction is used to confirm past infection by Mycobacterium tuberculosis, and to determine the CMI of the host. In Japan, most individuals have CMI to PPD due to the nearly universal bacille Calmette-Guérin (BCG) vaccination in childhood. Transient tuberculin anergy has been observed (57-61%) [6,7] during the early stage of MP. TSUNEKAWA et al. [7] reported that blastogenic lymphocyte response to PPD and PPD-induced gamma-interferon (IFN-γ) production were significantly reduced in tuberculin-negative patients with MP. However, the relationship between the pattern of pulmonary lesions and host CMI level in MP has not been evaluated.The findings of chest radiography of MP are varied; CLYDE [8] noted four frequent patterns suggesting MP: bronchopneumonia; nodular infiltration; plate-like atelectasis; and hilar adenopathy. Bronchopneumonia of MP is accompanied by thickening of bronchi, streaks of interstitial infiltration, and small areas of subsegmental atelectasis. The changes are produced by the presence of peribronchial inflammatory cell infiltrati...