Pulmonary alveolar proteinosis complicated with tuberculosis: A case report

Table 1 Laboratory results of the patient performed at West China Hospital

Laboratory examination	Result	Reference range
White blood cells (× 109/L)	5.74	3.5-9.5
Red blood cells (× 1012/L)	5.28	4.3-5.8
Platelets (× 109/L)	227	100-300
Prothrombin time (s)	13.7 ↑	9.6-12.8
International normalized ratio	1.17 ↑	0.88-1.15
Erythrocyte sedimentation rate (mm/h)	32.0 ↑	< 21
C-reactive protein (mg/L)	15.60 ↑	< 5
Interleukin-6 (pg/mL)	19.26 ↑	0.00-7.00
Procalcitonin (ng/mL)	0.05 ↑	< 0.046
Arterial blood gases
SpO2 (%)	93.4 ↓	95-98
PaO2 (mmHg)	64.8 ↓	80-100
PaCO2 (mmHg)	42	35-45
pH	7.40	7.35-7.45
Interferon-gamma release assay	Positive	Negative
Mycobacterium tuberculosis antibody	Positive	Negative

Table 2 Main characteristics of previously reported cases of pulmonary alveolar proteinosis complicated by tuberculosis

Ref.	Country	Sex	Age	Main manifestations	Sequential order	Diagnosis method	Main treatment	Prognosis	Other diseases
Ramirez[14], 1967	United States	Male	48	Pulmonary infiltrates	TB before PAP	Open lung biopsy	Bronchopulmonary lavage	Remission	None
Lathan et al[15], 1971	United States	Female	41	Chills, fever, productive cough, diffuse pulmonary infiltrates, and progressive dyspnea	PAP before TB	Open lung biopsy	Single lung lavage	Remission	None
Reyes and Putong[13], 1980	United States	Female	32	Fever, cough, and pulmonary cavities	TB before PAP	Open lung biopsy	Bronchopulmonary lavage	Unknown	Total gastrectomy and alcoholic hepatitis
Rekha et al[16], 1996	India	Male	26	Dyspnea and dry cough	PAP before TB	Open lung biopsy	Anti-tuberculosis therapy	Remission	None
Pereira-Silva et al[17], 2002	Brazil	Female	35	Dry cough, chest pain, mild dyspnea, and fever	At the same time	Open lung biopsy	Bronchoalveolar lavage	Unknown	Diabetes mellitus
Mayoralas Alises et al[18], 2003	Spain	Female	41	Night sweats, dyspnea, productive cough, and weight loss	TB before PAP	Bronchoscopy	Bronchoalveolar lavage	Remission	None
Yin et al[19], 2008	China	Female	17	Cough, expectoration, dyspnea on exertion, fever, and night sweats	At the same time	Transbronchial biopsy	Anti-tuberculous therapy and lung lavage	Improve	None
Tekgül et al[20], 2012	Turkey	Male	46	Dyspnea, cough, and fever	PAP before TB	Transbronchial biopsy	Anti-tuberculosis therapy	Improve	None
Huang et al[21], 2012	China	Male	35	Dyspnea and productive cough	TB before PAP	Bronchoalveolar lavage	Whole lung lavage	Improve	Partial gastrectomy and aspergilloma
Cheraghvandi et al[22], 2014	Iran	Male	29	Progressive dyspnea, weakness, cough, fever, and chills	TB before PAP	Transbronchial biopsy	Anti-tuberculosis therapy	Died	Acute silicosis
Nimmatoori et al[23], 2020	United States	Male	32	Progressive dry cough and breathlessness	TB before PAP	Bronchoalveolar lavage	Whole lung lavage	Remission	None

PAP: Pulmonary alveolar proteinosis; TB: Tuberculosis.