Pulmonary alveolar proteinosis after lung transplantation
| Autor: | Tharushi A. De Silva, Simon H. Apte, Daniel C. Chambers, Chandima Divithotawela, M. E. Tan |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Pulmonary and Respiratory Medicine
Pathology medicine.medical_specialty pulmonary alveolar proteinosis medicine.medical_treatment Interleukin‐1β Case Report Case Reports Lung biopsy 03 medical and health sciences Idiopathic pulmonary fibrosis 0302 clinical medicine Eosinophilic medicine Lung transplantation lipofuscin lcsh:RC705-779 medicine.diagnostic_test business.industry whole lung lavage Type-II Pneumocytes lcsh:Diseases of the respiratory system respiratory system Hyperplasia medicine.disease lung transplant respiratory tract diseases Bronchoalveolar lavage 030228 respiratory system 030220 oncology & carcinogenesis Pulmonary alveolar proteinosis business |
| Zdroj: | Respirology Case Reports Respirology Case Reports, Vol 8, Iss 5, Pp n/a-n/a (2020) |
| ISSN: | 2051-3380 |
| DOI: | 10.1002/rcr2.566 |
| Popis: | We report the case of a 69‐year‐old man five‐month post double lung transplant for idiopathic pulmonary fibrosis (IPF) who presented with progressive breathlessness, loss of lung function, and diffuse ground glass shadowing on the chest computed tomography. Transbronchial lung biopsy revealed foamy macrophages, hyperplasia of type II pneumocytes, and eosinophilic material in the alveolar space. Video thoracic lung biopsy was performed, and histology confirmed pulmonary alveolar proteinosis. Anti‐granulocyte‐macrophage colony‐stimulating factor (GM‐CSF) antibodies were negative. Bilateral sequential whole lung lavage (WLL) was performed. Lavage fluid recovered during WLL was notably dark brown in colour and upon analysis was shown to contain heavily oxidized protein (lipofuscin), giant lipofuscin‐engorged macrophages, and a highly pro‐inflammatory gene expression profile. Following WLL, the patient's symptoms, lung function, and radiology appearance improved. His repeat bronchoalveolar lavage (BAL) fluid analysis showed reduced lipofuscin and normalized macrophage size and gene expression. Here, we report a case of secondary pulmonary alveolar proteinosis (PAP) after double lung transplantation with highly oxidized protein and pro‐inflammatory gene expression in whole lung lavage (WLL) fluid. Our patient was successfully treated with WLL. His repeat bronchoalveolar lavage (BAL) fluid analysis showed reduced lipofuscin and normalized macrophage size and gene expression. |
| Databáze: | OpenAIRE |
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