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Rare Cause of Secondary Pulmonary Alveolar Proteinosis
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A6476 - Rare Cause of Secondary Pulmonary Alveolar Proteinosis
Author Block: S. Hemvimon1, S. Supawita1, P. Sriwichian2, A. Sakulchan3; 1Medicine, Saraburi Hospital, Saraburi, Thailand, 2Pathology, Saraburi Hospital, Saraburi, Thailand, 3Radiology, Saraburi Hospital, Saraburi, Thailand.
Secondary pulmonary alveolar proteinosis (PAP) associated with occupational exposure in the form of acute silicoproteinosis is rare. The reported case suffered with PAP in association with long-lasting exposure to silica dust under working environment. A 43-year-old man with a history of 10-pack year cigarette smoking developed dyspnea on exertion and unproductive cough for 4 months. He had been working as a brick maker and sanitary ware worker for 11 years with inconsistent compliance to respiratory protection device. On examination, his respiratory rate was 24/min and oxygen saturation was 94% at room air. No clubbing of fingers was detected. There were generalized rhonchi occupying in both lungs. His chest radiograph revealed diffused bilateral alveolar opacification, which was predominantly located in upper to middle lung compartments. Chest computer tomography showed diffuse ground glass opacity in combination with reticulonodular infiltrates and scattering consolidations in both lung fields. Flexible fiberoptic bronchoscopy failed to detect endobronchial lesions and provided milky appearance of BAL fluid in the presence of lymphocytic alveolitis. Cytologic BAL analysis showed acellular eosinophilic material positive for PAS staining. Finally, without undergoing whole lung lavage, he was clinically improved after discontinuation of silica exposure.
Author Block: S. Hemvimon1, S. Supawita1, P. Sriwichian2, A. Sakulchan3; 1Medicine, Saraburi Hospital, Saraburi, Thailand, 2Pathology, Saraburi Hospital, Saraburi, Thailand, 3Radiology, Saraburi Hospital, Saraburi, Thailand.
Secondary pulmonary alveolar proteinosis (PAP) associated with occupational exposure in the form of acute silicoproteinosis is rare. The reported case suffered with PAP in association with long-lasting exposure to silica dust under working environment. A 43-year-old man with a history of 10-pack year cigarette smoking developed dyspnea on exertion and unproductive cough for 4 months. He had been working as a brick maker and sanitary ware worker for 11 years with inconsistent compliance to respiratory protection device. On examination, his respiratory rate was 24/min and oxygen saturation was 94% at room air. No clubbing of fingers was detected. There were generalized rhonchi occupying in both lungs. His chest radiograph revealed diffused bilateral alveolar opacification, which was predominantly located in upper to middle lung compartments. Chest computer tomography showed diffuse ground glass opacity in combination with reticulonodular infiltrates and scattering consolidations in both lung fields. Flexible fiberoptic bronchoscopy failed to detect endobronchial lesions and provided milky appearance of BAL fluid in the presence of lymphocytic alveolitis. Cytologic BAL analysis showed acellular eosinophilic material positive for PAS staining. Finally, without undergoing whole lung lavage, he was clinically improved after discontinuation of silica exposure.
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