Chest
Selected ReportsPulmonary Alveolar Proteinosis in a Painter With Elevated Pulmonary Concentrations of Titanium
Section snippets
Case Report
A 43-year-old man with severe shortness of breath and cough, intermittently producing large quantities of a thick yellowish material developed significant restrictive lung disease with severe hypoxemia (Table 1). His chest radiograph showed bilateral interstitial and alveolar infiltrates. His past medical history included regular use of alcohol up to 3 years prior to hospital admission. He had formerly snorted cocaine, but denied using intravenous drugs. He denied homosexual contact or contact
Histologic Studies
Tissues were stained with hematoxylin-eosin; Prussian blue; Gomori's methenamine-silver (GMS); periodic acid-Schiff (PAS); and acid-fast bacilli (AFB) stains. The alveoli were distended with a pink homogeneous material that was PAS positive. Sections of the right middle lobe showed normal thin, delicate alveolar septa, whereas the right lower lobe showed a mixture of alveolar proteinosis with focally fibrotic alveolar septa with organizing granulation tissue, lymphocytes, and fewer plasma cells
Treatment and Progress
The patient required total bilateral lung lavage on two different occasions, 3 months apart. An average of 34 L of saline solution was used for each lung, under general anesthesia in two stages; the most damaged lung lavaged first, and the second lung lavaged 5 days later. Each time, the lavage initially returned a typical milky appearance; once the fluid was left to sedimentate, it showed the typical presence of an upper foamy layer, a middle whitish layer, and a dense concentration of thick
Discussion
PAP is characterized by deposition of proteinaceous material in air spaces. This material consists of lipid bilayer membranes separated by amorphous proteinaceous material10 containing phospholipids and proteins similar to surfactant or one of its components. The cause remains unclear, but it is likely related to either overstimulation of type II pneumocytes or an impairment in the mechanisms for removal of alveolar phospholipids.11 Abraham and McEuen, in 197812 and 198613 described their
Acknowledgment
The authors express appreciation to Mrs. Gina Buchanan for her contribution to this publication.
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