title: Pulmonary alveolar proteinosis.
abstract: Three adult patients, two of whom were HIV-seropositive, presented with a dyspnea of two-to-three-day duration associated with dry cough. High-resolution CT scans of the chest revealed a widespread air-space consolidation with "crazy-paving" pattern in all cases, suggesting a pulmonary alveolar proteinosis (PAP). Bronchoalveolar lavage (BAL) retrieved varying amounts of turbid fluid containing abundant, coarsely granular material that stained positively using periodic acid-Schiff (PAS) and PAS with prior diastase digestion. Pneumocystis carinii (PC) cysts were identified in Gomori methenamine silver-stained BAL sediments obtained from the two HIV-positive patients. By electron microscopy, numerous myelin figures were found in the BAL sediments in all cases, confirming a PAP. Histologic examination of lung tissues obtained by open biopsy confirmed a PAP in two cases, with one case showing, in addition, PC cysts.
authors.affiliation: Department of Pathology, St. Agnes Medical Center, Fresno, CA, USA.
authors.forename: Marie-Rose
authors.initials: MR
authors.lastname: Akin
authors.forename: Gia-Khanh
authors.initials: GK
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D000818:Animals; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D003560:Cysts / Q000382:microbiology / Q000648:ultrastructure; D003937:Diagnosis, Differential; D005260:Female; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000378:metabolism; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D046529:Microscopy, Electron, Transmission; D008875:Middle Aged; D045363:Pneumocystis carinii; D011020:Pneumonia, Pneumocystis / Q000150:complications / Q000473:pathology; D011649:Pulmonary Alveolar Proteinosis / Q000382:microbiology / Q000473:pathology*
chemical_list: D016178:Granulocyte-Macrophage Colony-Stimulating Factor