Résumé
From 1983 to 2001, 7 patients with pulmonary alveolar proteinosis were admitted to the King Chulalongkorn Memorial Hospital. Presenting symptoms varied from asymptomatic (1 patient), progressive dyspnea on exertion (4 patients) to respiratory failure (2 patients). Other symptoms included dry cough and weight loss. Gradual onset of dyspnea could be observed by average time to hospital (7 months). Early worsening of dyspnea and high-grade fever suggested a possibility of superimposed infection. Chest radiographs revealed symmetrical infiltration without lobar predominance. 4 of 7 patients were misdiagnosed as pulmonary tuberculosis before diagnosis of PAP was made. Diagnosis was made by bronchoscopic examination with typical lavage fluid or pathological results; only one case need open lung biopsy. 6 of 7 patients required lung lavage to relieve dyspneic symptoms. Coinfection with Nocardia and Mycobacterium tuberculosis was found in one patient. Prognosis was good but recurrence was common.
Sujets)
Adulte , Sujet âgé , Lavage bronchoalvéolaire , Bronchoscopie , Évolution de la maladie , Femelle , Humains , Mâle , Adulte d'âge moyen , Protéinose alvéolaire pulmonaire/diagnostic , Alvéoles pulmonaires/physiopathologie , Études rétrospectives , ThaïlandeRésumé
A 67-year-old diabetic man presented with progressive multifocal myeloradiculopathy for 6 months, with no pulmonary symptoms. A chest x-ray and CT scan of the lungs revealed bilateral multiple nodular infiltrates in the right upper lobe and the lower lobes bilaterally, mimicking metastases. A thoracoscopic lung biopsy demonstrated bronchiolitis obliterans organizing pneumonia caused by capsule-deficient cryptococcosis.