title: Serial lobar lung lavage in pulmonary alveolar proteinosis.
abstract: Pulmonary alveolar proteinosis (PAP) is a rare disease with worldwide distribution and an estimated incidence of 0.36 cases per million. We report a case of a PAP coexisting with Pneumocystis jiroveci pneumonia and Mycobacterium tuberculosis infection. The patient was treated with serial lobar lung lavages, GM-CSF, cotrimoxazole, and antituberculosis drugs. His PaO2 on room air improved from 45.7 to 63.8 torr and pulmonary functions normalized (FVC 81.2%, FEV1 95.3%, FEV1/FVC 91.8). A high-resolution computed tomography scan of the thorax showed clearing of both lower lobes. Whole-lung lavage is used in the treatment of PAP, but it may worsen the hypoxemia and lead to hemodynamic instability during the procedure. To the best of our knowledge, there are no reports of bronchoscopic serial lobar lung lavages in cases of PAP performed in India. This method can be performed in bronchoscopic suites having general anesthesia facilities without the requirement of special gadgets.
authors.affiliation: Departments of *Chest Medicine and EPRC †Anesthesiology ‡Pathology, Seth GS Medical College and KEMH, Mumbai, Maharashtra, India.
authors.forename: Milind M
authors.initials: MM
authors.lastname: Baldi
authors.forename: Jairaj
authors.initials: J
authors.lastname: Nair
authors.forename: Amita
authors.initials: A
authors.lastname: Athavale
authors.forename: Varun
authors.initials: V
authors.lastname: Gavali
authors.forename: Manjula
authors.initials: M
authors.lastname: Sarkar
authors.forename: Smita
authors.initials: S
authors.lastname: Divate
authors.forename: Unmil
authors.initials: U
authors.lastname: Shah
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use; D018893:Bronchoalveolar Lavage / Q000009:adverse effects / Q000379:methods*; D001999:Bronchoscopy / Q000379:methods*; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D007194:India; D008297:Male; D010100:Oxygen / Q000097:blood; D010503:Periodic Acid-Schiff Reaction; D011020:Pneumonia, Pneumocystis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D011649:Pulmonary Alveolar Proteinosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D012121:Respiration, Artificial; D012129:Respiratory Function Tests; D014057:Tomography, X-Ray Computed; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage / Q000627:therapeutic use; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy
chemical_list: D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D016178:Granulocyte-Macrophage Colony-Stimulating Factor; D010100:Oxygen