Le-Khac Bao, Tran-Le Quoc-Khanh, Nguyen-Ho Lam, Duong-Quy Sy
Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
Respiratory Department, Cho Ray Hospital, Ho Chi Minh City, Vietnam.
Pulm Ther. 2023 Jun;9(2):287-293. doi: 10.1007/s41030-023-00224-0. Epub 2023 May 11.
Pulmonary alveolar proteinosis (PAP) is an uncommon disease and its diagnosis remains challenging. During the COVID-19 pandemic, it has been difficult to distinguish between PAP and post-COVID-19 pulmonary sequelae. Here we present a case of a 44-year-old male patient who experienced exertional dyspnea after recovering from COVID-19. He was initially diagnosed with post-COVID-19 syndrome and treated with systemic corticosteroid without improvement. Chest computed tomography (CT) showed crazy-paving pattern with ground-glass opacities. Fibreoptic bronchoscopy with bronchial lavage fluid (BLF) analysis confirmed the final diagnosis of PAP. The patient underwent left lung lavage in combination with conventional therapy and experienced significant improvement in his respiratory condition and overall health during follow-up. Hence, PAP could occur after a COVID-19 infection. This case highlights the importance of considering PAP as a potential diagnosis in patients with persistent respiratory symptoms after COVID-19. The high suspicion indicators of PAP revealed by chest-CT and BLF may be a key to differentiating PAP from post-COVID-19 pulmonary sequelae. Moreover, it is plausible that SARS-CoV-2 plays a role in the development of proteinosis, either by inducing a flare-up or by directly causing the condition.
肺泡蛋白沉积症（PAP）是一种罕见疾病，其诊断仍然具有挑战性。在新冠疫情期间，很难区分PAP和新冠后肺部后遗症。在此，我们报告一例44岁男性患者，他在新冠康复后出现劳力性呼吸困难。他最初被诊断为新冠后综合征，并接受全身糖皮质激素治疗，但病情无改善。胸部计算机断层扫描（CT）显示有磨玻璃影的铺路石样表现。纤维支气管镜检查及支气管肺泡灌洗（BAL）液分析确诊为PAP。患者接受了左肺灌洗联合传统治疗，随访期间呼吸状况和整体健康状况有显著改善。因此，PAP可在新冠感染后发生。该病例强调了在新冠后持续有呼吸道症状的患者中考虑PAP作为潜在诊断的重要性。胸部CT和BAL显示的PAP高疑似指标可能是区分PAP与新冠后肺部后遗症的关键。此外，严重急性呼吸综合征冠状病毒2（SARS-CoV-2）通过诱发病情加重或直接导致该病，在蛋白沉积症的发生发展中发挥作用这一说法似乎是合理的。
