Jian L, Zhao QQ. Unexpected diffuse lung lesions in a patient with pulmonary alveolar proteinosis: A case report. World J Clin Cases 2023; 11(20): 4932-4936 [PMID: 37583994 DOI: 10.12998/wjcc.v11.i20.4932]
Corresponding Author of This Article
Qi-Quan Zhao, MMed, Department of Respiratory and Critical Care Medicine, Dazu Hospital of Chongqing Medical University, The People's Hospital of Dazu, No. 1073 2nd Ring South Road, Tangxiang Street, Dazu District, Chongqing 402360, China. 316318057@qq.com
Research Domain of This Article
Respiratory System
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jul 16, 2023; 11(20): 4932-4936 Published online Jul 16, 2023. doi: 10.12998/wjcc.v11.i20.4932
Unexpected diffuse lung lesions in a patient with pulmonary alveolar proteinosis: A case report
Li Jian, Qi-Quan Zhao
Li Jian, Department of Endocrinology, Dazu Hospital of Chongqing Medical University, The People's Hospital of Dazu, Chongqing 402360, China
Qi-Quan Zhao, Department of Respiratory and Critical Care Medicine, Dazu Hospital of Chongqing Medical University, The People's Hospital of Dazu, Chongqing 402360, China
Author contributions: Jian L contributed to writing the manuscript and participated in helpful discussions; Zhao QQ is the guarantor of this work.
Supported bythe Joint Project of Chongqing Health Commission and Science and Technology Bureau, No. 2022MSXM103.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest and agreed to publish the study.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qi-Quan Zhao, MMed, Department of Respiratory and Critical Care Medicine, Dazu Hospital of Chongqing Medical University, The People's Hospital of Dazu, No. 1073 2nd Ring South Road, Tangxiang Street, Dazu District, Chongqing 402360, China. 316318057@qq.com
Received: March 20, 2023 Peer-review started: March 20, 2023 First decision: May 31, 2023 Revised: June 9, 2023 Accepted: June 26, 2023 Article in press: June 26, 2023 Published online: July 16, 2023 Processing time: 108 Days and 22.3 Hours
Abstract
BACKGROUND
Pulmonary alveolar proteinosis (PAP) often presents nonspecifically and can be easily confused with: (1) Idiopathic interstitial lung fibrosis; (2) alveolar carcinoma; (3) pulmonary tuberculosis; and (4) other lung diseases such as viral pneumonia, mycoplasma pneumonia, and chlamydial pneumonia.
CASE SUMMARY
Diagnosis: In this case, a patient was diagnosed with PAP through transbronchial cryobiopsy (TBCB) and quantitative metagenomic next-generation sequencing, which confirmed the impairment of surfactant turnover as the underlying cause of PAP. Interventions: High-volume total lung lavage was performed for this patient. Outcomes: The patient's clinical condition had improved significantly by the 6-month follow-up, with a 92% finger oxygen saturation. A repeat chest computed tomography scan revealed scattered patchy ground-glass shadows in both lungs, which was consistent with alveolar protein deposition but with a lower density than in the radiograph from October 23, 2022.
CONCLUSION
TBCB has unique advantages in diagnosing atypical alveolar protein deposition, particularly for enabling the early detection of PAP. This information can help patients take preventive measures to prevent or halt PAP development by avoiding dusty environments and seeking treatment with total lung lavage and inhaled granulocyte macrophage colony-stimulating factor.
Core Tip: Pulmonary alveolar proteinosis (PAP) is frequently misdiagnosed due to the absence of typical map-like and pavement-like manifestations in the lungs or the absence of typical pathological findings. Transbronchial cryobiopsy has unique advantages in diagnosing atypical alveolar protein deposition, particularly for enabling the early detection of PAP. This information can help patients take preventive measures to prevent or halt PAP development by avoiding dusty environments and seeking treatment with total lung lavage and inhaled granulocyte macrophage colony-stimulating factor.
