COVID-19 and severe pulmonary alveolar proteinosis (PAP): A case report.

Autor:	Melhem AB; Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, PO Box: 630001, Irbid, 22110, Jordan., Seif AM; Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, PO Box: 630001, Irbid, 22110, Jordan., Omar OH; Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, PO Box: 630001, Irbid, 22110, Jordan., Al Bashir S; Department of Pathology and Microbiology, Faculty of Medicine, Jordan University of Science and Technology, PO Box: 630001, Irbid, 22110, Jordan., Samrah SM; Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, PO Box: 630001, Irbid, 22110, Jordan.
Jazyk:	angličtina
Zdroj:	Heliyon [Heliyon] 2023 Jul 07; Vol. 9 (7), pp. e18099. Date of Electronic Publication: 2023 Jul 07 (Print Publication: 2023).
DOI:	10.1016/j.heliyon.2023.e18099
Abstrakt:	Background: Pulmonary alveolar proteinosis (PAP) is a rare lung disease that mainly presents with dyspnea. PAP diagnosis can be easily missed in the background of a coronavirus disease 2019 (COVID-19) infection, due to the similarity of their presentation and radiological findings. We present a case report of a post-COVID-19 patient, who later developed severe PAP. Case Presentation: A 55-year-old male patient presented to the emergency department with progressive exertional dyspnea and hypoxia following a COVID-19 infection. Chest X-ray showed severe bilateral infiltrates. Patient received multiple courses of broad-spectrum antibiotics and prolonged course of corticosteroids without improvement. "Crazy paving" appearance in a follow up chest computed tomography raised the suspicion of PAP of what was initially thought to be a post-COVID-19 syndrome presentation. A diagnostic segmental bronchioalveolar lavage with a lung biopsy revealed a proteinaceous material filling the alveoli, with a positive periodic acid-Schiff (PAS) stain. Due to severe hypoxia, therapeutic segmental followed by whole lung lavage was performed with significant improvement. Conclusion: Diagnosing PAP is challenging due to the rarity of the disease. An accurate diagnosis of PAP requires a combination of medical history, imaging, and bronchoalveolar lavage staining positive for PAS. Decision whether to treat with a segmental or whole lung lavage is individualized to each patient. Further studies are needed to confirm whether COVID-19 or long-term use of steroids might be contributing to PAP. Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper (© 2023 The Authors.)
Databáze:	MEDLINE
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