title: Pulmonary alveolar proteinosis in association with household exposure to fibrous insulation material.
abstract: We report the case of a 35-year-old woman who developed pulmonary alveolar proteinosis requiring multiple lavage treatments, in association with household exposure to ventilation system dust comprised at least partially by a cellulose fire-resistant fibrous insulation material. Scanning electron microscopy with energy-dispersive x-ray analysis documented the presence of spectral peaks consistent with the insulation material in transbronchial biopsy tissue. The patient showed symptomatic improvement once exposure to the insulation material had ceased. We believe that this case demonstrates an unusual association with pulmonary alveolar proteinosis. This case emphasizes the broad differential diagnosis for this histologic injury pattern and the need to thoroughly investigate environmental exposures in patients with unexplained pulmonary disease.
authors.affiliation: Department of Pathology, St. Louis University Medical Center, MO 63110-0250, USA. mcdonalj@sluh.edu
authors.forename: J W
authors.initials: JW
authors.lastname: McDonald
authors.forename: F
authors.initials: F
authors.lastname: Alvarez
authors.forename: C A
authors.initials: CA
authors.lastname: Keller
mesh_terms: D000328:Adult; D016902:Air Pollution, Indoor / Q000009:adverse effects*; D002482:Cellulose / Q000009:adverse effects*; D003252:Construction Materials / Q000009:adverse effects*; D004391:Dust / Q000009:adverse effects; D005260:Female; D006801:Humans; D008168:Lung / Q000473:pathology; D008855:Microscopy, Electron, Scanning; D019016:Mineral Fibers / Q000009:adverse effects*; D011649:Pulmonary Alveolar Proteinosis / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology
chemical_list: D004391:Dust; D019016:Mineral Fibers; D002482:Cellulose