ABSTRACT
Pulmonary alveolar proteinosis (PAP) is a rare disorder in which lipoproteinaceous material is deposited in the alveoli, compromising gaseous exchange. We report the case of a 29-year-old female patient presenting with the most extreme case of PAP yet reported. She successfully managed by aggressive bilateral whole lung lavage (WLL) in a single sitting using extracorporeal membrane oxygenation (ECMO) support. Despite critical hypercarbia and ventilator-dependence for 12 days before lavage, the patient experienced rapid recovery of pulmonary function after WLL and ECMO could be discontinued on-table. Aggressive WLL with ECMO support can be safe and effective even in the most severe cases of PAP.
Subject(s)
Extracorporeal Membrane Oxygenation/methods , Pulmonary Alveolar Proteinosis/diagnosis , Pulmonary Alveolar Proteinosis/therapy , Adult , Bronchoalveolar Lavage/methods , Bronchoscopy , Disease Progression , Female , Fiber Optic Technology , Follow-Up Studies , Humans , Pulmonary Gas Exchange , Radiography, Thoracic , Respiration, Artificial/methods , Risk Assessment , Severity of Illness Index , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
We report the case of a physically fit young man who presented with severe, life-threatening heat stroke after running a 10 km road race. He had previously received bilateral thoracic sympathectomy for axillary hyperhidrosis at another hospital, and was known to have upper body and limb anhidrosis. Thoracic sympathectomy can result in reduced sweating and disturbed peripheral vascular and heart rate responses. Patients should be warned that these mechanisms may play a role in the development of exertional heat stroke.
