A Case of Pulmonary Alveolar Proteinosis Associated with Pulmonary Tuberculosis / 결핵

ABSTRACT

Pulmonary alveolar proteinosis(PAP) is a disorder in which an insoluble, proteinaceous material, rich in phospholipids, is deposited in the alveoli and bronchioles. The deficiency in the clearance and degradation of the i ntra-alveolar phospholipoproteinaceous material in PAP most likely represents a dysfunction of the type II pneumocytes. Although the pathogenesis and causative treatment of PAP is unclear a whole lung bronchopulmonary lavage is a relatively safe and effective treatment. Here we experienced a case of pulmonary alveolar proteinosis in a 62 year old female patient who had pulmonary tuberculosis approximately 20 years ago. She complained of aggravated dyspnea and chronic cough, and presented fine inspiratory crackles at both lung fields. diffuse ground glass opacity with some area of consolidation and smooth interlobular septal thickenings in both upper, right middle lobes, and a portion of right lower lobe. Optical microscopy of the lung tissue obtained by an open lung biopsy many granulomas containing acid-fast smear positive bacilli and diffuse homogeneous PAS-positive fluid in the alveolar space. Immunohistochemical stain showed surfactant A in the alveolar space. Antituberculosis drugs with bronchoalveolar lavage were used to treat the disease. There after she showed improvement in her symptoms and a partial improvement in the chest X-ray and HRCT findings. We present a case of PAT associated with pulmonary tuberculosis.