Published online Apr 26, 2021. doi: 10.12998/wjcc.v9.i12.2874
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
Processing time: 134 Days and 14.8 Hours
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.
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.
When evaluating patients presenting with PAP and pulmonary infections, the potential for nocardiosis should be considered.
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.