Pulmonary alveolar proteinosis complicated with tuberculosis: A case report

doi:10.12998/wjcc.v9.i17.4400

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World Journal of Clinical Cases

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Case Report

World J Clin Cases. Jun 16, 2021; 9(17): 4400-4407
Published online Jun 16, 2021. doi: 10.12998/wjcc.v9.i17.4400

Pulmonary alveolar proteinosis complicated with tuberculosis: A case report

Hao Bai, Zi-Rui Meng, Bin-Wu Ying, Xue-Rong Chen

Hao Bai, Zi-Rui Meng, Bin-Wu Ying, Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China

Xue-Rong Chen, Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China

Author contributions: Bai H and Meng ZR collected and analyzed the patient data, and were major contributors in writing the manuscript; Chen XR and Ying BW interpreted the patient data; all authors read and approved the final manuscript.

Supported by the National Science and Technology Major Project of the Ministry of Science and Technology of China, No. 2018ZX10715-003.

Informed consent statement: Case report analysis used anonymous data and unidentifiable images that were obtained after the patient agreed to treatment with written consent.

Conflict-of-interest statement: The authors have no conflicts of interest to disclose.

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).

Corresponding author: Xue-Rong Chen, PhD, Chief Doctor, Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu 610041, Sichuan Province, China. xuerongchenchen@163.com

Received: February 1, 2021
Peer-review started: February 1, 2021
First decision: February 25, 2021
Revised: March 12, 2021
Accepted: April 8, 2021
Article in press: April 8, 2021
Published online: June 16, 2021
Processing time: 113 Days and 18.5 Hours

Abstract

BACKGROUND

Pulmonary alveolar proteinosis (PAP) is a rare lung disease characterized by the accumulation of phospholipoproteinaceous material in the alveoli. Cases of PAP complicated with tuberculosis are much more complex and have rarely been well recorded.

CASE SUMMARY

We describe a 21-year-old Han Chinese patient with suspicious lung infection associated with mild restrictive ventilatory dysfunction and diffusion reduction. High resolution computed tomography revealed a “crazy-paving” appearance and multiple pulmonary miliary nodules around the bronchi. Bronchoalveolar lavage demonstrated a small amount of periodic acid-Schiff positive proteinaceous materials. A serological test for the presence of a Mycobacterium tuberculosis antibody and an interferon-gamma release assay were both positive. The patient received a standard course of first-line anti-tuberculosis treatment after diagnostic bronchoalveolar lavage. To date, clinical remission has been achieved and maintained for five years.

CONCLUSION

In summary, the diagnosis of PAP complicated with tuberculosis was supported by a combination of clinical manifestations, imaging, pulmonary function, laboratory examinations, bronchoalveolar lavage, etc. This case highlighted that diagnostic bronchoalveolar lavage in combination with anti-tuberculosis treatment is a safe and effective option for mild PAP patients with tuberculosis.

Keywords: Pulmonary alveolar proteinosis; Pulmonary tuberculosis; Bronchoalveolar lavage; Case report

Core Tip: Pulmonary alveolar proteinosis (PAP) complicated with tuberculosis is a rare clinical situation. This case highlighted that diagnostic bronchoalveolar lavage in combination with anti-tuberculosis treatment is a safe and effective option for mild PAP patients with tuberculosis. Bronchoalveolar lavage did not induce the dissemination of tuberculosis because anti-tuberculosis drugs were used immediately.