title: A novel immunodeficiency syndrome as a rare cause of secondary pulmonary alveolar proteinosis: a diagnosis after 5 decades.
abstract: Case report of a male patient with a five-decade follow-up history in a tertiary care hospital distinguished for malabsorption syndrome, failure-to-thrive, meningitis and recurrent bacterial, fungal and mycobacterial pulmonary infections. Additionally, he developed epidermodysplasia verruciformis, several in situ spinocellular carcinomas and an uncharacteristic parenchymal lung disease. Surgical lung biopsy suggested pulmonary alveolar proteinosis with fibrotic change. Retrospectively, severe monocytopenia had been overlooked in the past, as well as low B and NK cell blood counts. Flow cytometry confirmed the absence of the previous cell subsets along with an undetectable population of dendritic blood cells. Dendritic cell, monocyte, B and NK lymphoid Human Deficiency Syndrome (DCMLS) is a novel rare immunodeficiency described in 2010, linked to GATA-2 mutation. This syndrome should be highlighted as a rare cause of acquired PAP, with a radiological pattern encompassing potential fibrotic change. Failure to recognize monocytopenia may impede the chance to diagnose.
authors.affiliation: Pulmonology Department, Coimbra Hospital and University Centre, Coimbra, Portugal. Electronic address: p_goncalof@hotmail.com.
authors.forename: Pedro G
authors.initials: PG
authors.lastname: Ferreira
authors.affiliation: Anatomopathology Department, Coimbra Hospital and University Centre, Coimbra, Portugal.
authors.forename: Lina
authors.initials: L
authors.lastname: Carvalho
authors.affiliation: Pulmonology Department, Coimbra Hospital and University Centre, Coimbra, Portugal.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Gamboa
mesh_terms: D001402:B-Lymphocytes; D003713:Dendritic Cells; D006801:Humans; D007153:Immunologic Deficiency Syndromes / Q000150:complications* / Q000175:diagnosis*; D007694:Killer Cells, Natural; D008297:Male; D008875:Middle Aged; D009000:Monocytes; D011649:Pulmonary Alveolar Proteinosis / Q000209:etiology*; D013997:Time Factors
keywords: Alveolar Pulmonary Proteinosis; Doença pulmonar parenquimatosa; Doença sistémica com envolvimento pulmonar; Immunodeficiency; Imunodeficiência; Parenchymal lung disease; Proteinose Alveolar Pulmonar; Systemic disease with lung involvement