title: Pulmonary alveolar proteinosis and first successful whole lung lavage in Sri Lanka: a case report.
abstract: BACKGROUND
  Pulmonary alveolar proteinosis is a rare disease characterized by accumulation of lipoproteinaceous material within alveoli. There are three clinically distinct forms: congenital, acquired and secondary. Whole lung lavage is currently the gold standard therapy for severe cases of pulmonary alveolar proteinosis. In Sri Lanka this is the first reported successful whole lung lavage for a patient with pulmonary alveolar proteinosis.
  
  
  METHODS
  We describe the case of a 15-year-old Sri Lankan girl who presented with symptoms of progressive shortness of breath and dry cough for 6 months' duration. She had a history of exposure to silica in her household environment. High-resolution computed tomography revealed crazy paving appearance in both lungs suggestive of pulmonary alveolar proteinosis. An open lung biopsy revealed intra-alveolar granular amphophilic material which was strongly periodic acid-Schiff positive and diastase resistant, which is consistent with pulmonary alveolar proteinosis. She was followed up for 2 years with periodical segmental bronchoalveolar lavages which showed minimal improvement in her symptoms as well as in exercise desaturation. Due to severe dyspnea and hypoxemia on exertion, she underwent whole lung lavage. It resulted in a marked improvement in her symptoms, exercise desaturation, and chest X-ray results.
  
  
  CONCLUSIONS
  Whole lung lavage was successfully performed for the first time in Sri Lanka for a patient with pulmonary alveolar proteinosis.
authors.affiliation: Department of Respiratory Medicine, National Hospital for Respiratory Diseases, Welisara, Sri Lanka. janithgalhenage@yahoo.co.uk.
authors.forename: Janith
authors.initials: J
authors.lastname: Galhenage
authors.affiliation: Department of Respiratory Medicine, National Hospital for Respiratory Diseases, Welisara, Sri Lanka.
authors.forename: Buddhika
authors.initials: B
authors.lastname: Weerasinghe
authors.affiliation: Department of Respiratory Medicine, National Hospital for Respiratory Diseases, Welisara, Sri Lanka.
authors.forename: Wadasinghe
authors.initials: W
authors.lastname: Dilesha
authors.affiliation: Department of Pathology, National Hospital for Respiratory Diseases, Welisara, Sri Lanka.
authors.forename: Roshana
authors.initials: R
authors.lastname: Constantine
authors.affiliation: Department of Respiratory Medicine, National Hospital for Respiratory Diseases, Welisara, Sri Lanka.
authors.forename: Bandu
authors.initials: B
authors.lastname: Gunasena
mesh_terms: D000293:Adolescent; D018893:Bronchoalveolar Lavage / Q000379:methods; D003371:Cough / Q000209:etiology; D004417:Dyspnea / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology*; D011649:Pulmonary Alveolar Proteinosis / Q000175:diagnosis* / Q000473:pathology; D013188:Sri Lanka; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Bronchoalveolar lavage; Case report; Pulmonary alveolar proteinosis; Whole lung lavage