Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 26, 2021; 9(12): 2874-2883
Published online Apr 26, 2021. doi: 10.12998/wjcc.v9.i12.2874
Pulmonary alveolar proteinosis complicated with nocardiosis: A case report and review of the literature
Xiao-Kang Wu, Quan Lin
Xiao-Kang Wu, Quan Lin, Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, Zhejiang Province, China
Author contributions: Lin Q and Wu XK treated the patient; Lin Q performed the histological examination and analysis of the biopsied specimen; Wu XK drafted the manuscript and submitted the final manuscript; all authors read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient and patient’s family for publication of this case report and accompanying images.
Conflict-of-interest statement: The authors declare that they have no competing interests to report.
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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Quan Lin, MM, Associate Chief Physician, Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, New Hospital of Nanbaixiang Wen Hospital, Nanbaixiang Street, Ouhai District, Wenzhou 325015, Zhejiang Province, China. lquan007@163.com
Received: December 1, 2020
Peer-review started: December 1, 2020
First decision: January 17, 2021
Revised: January 26, 2021
Accepted: February 22, 2021
Article in press: February 22, 2021
Published online: April 26, 2021
Abstract
BACKGROUND

Pulmonary alveolar proteinosis (PAP) is a pulmonary syndrome wherein large volumes of phospholipid and protein-rich surfactants accumulate within the alveoli. PAP forms include primary (auto-immune PAP), secondary, and congenital. Nocardiosis is a form of suppurative disease induced upon infection with bacteria of the Nocardia genus. Clinically, cases of PAP complicated with Nocardia infections are rare, regardless of form. Unfortunately, as such, they are easily overlooked or misdiagnosed. We describe, here, the case of a patient suffering from simultaneous primary PAP and nocardiosis.

CASE SUMMARY

A 45-year-old Chinese man, without history of relevant disease, was admitted to our hospital on August 8, 2018 to address complaints of activity-related respiratory exertion and cough lasting over 6 mo. Lung computed tomography (CT) revealed diffuse bilateral lung infiltration with local consolidation in the middle right lung lobe. Subsequent transbronchial lung biopsy and CT-guided lung biopsy led to a diagnosis of primary PAP (granulocyte-macrophage colony-stimulating factor antibody-positive) complicated with nocardiosis (periodic acid-Schiff-positive). After a 6 mo course of anti-infective treatment (sul-famethoxazole), the lesion was completely absorbed, such that only fibrous foci remained, and the patient exhibited significant symptom improvement. Follow-up also showed improvement in pulmonary function and the CT imaging findings of PAP. No whole-lung lavage has been conducted to date. This case highlights that active anti-nocardia treatment may effectively improve the symptoms and alleviate PAP in patients with PAP and nocardia, possibly reducing the need for whole-lung lavage.

CONCLUSION

When evaluating patients presenting with PAP and pulmonary infections, the potential for nocardiosis should be considered.

Keywords: Pulmonary alveolar proteinosis, Nocardiosis, Vitek mass spectroscopy, Whole-lung lavage, Case report

Core Tip: We present the case of a patient suffering from simultaneous primary pulmonary alveolar proteinosis (PAP) and nocardiosis. This case highlights the importance of considering the potential for nocardiosis when evaluating patients presenting with PAP and pulmonary infections. The successful management of our case also shows that active anti-nocardia treatment may effectively alleviate the concomitant PAP and may also reduce the need for whole-lung lavage.