Melhem Ahmad Basim, Seif Abdelsamea Mohammed, Omar Omar Husni, Al Bashir Samir, Samrah Shaher M
Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, PO Box: 630001, Irbid, 22110, Jordan.
Department of Pathology and Microbiology, Faculty of Medicine, Jordan University of Science and Technology, PO Box: 630001, Irbid, 22110, Jordan.
Heliyon. 2023 Jul 7;9(7):e18099. doi: 10.1016/j.heliyon.2023.e18099. eCollection 2023 Jul.
Pulmonary alveolar proteinosis (PAP) is a rare lung disease that mainly presents with dyspnea. PAP diagnosis can be easily missed in the background of a coronavirus disease 2019 (COVID-19) infection, due to the similarity of their presentation and radiological findings. We present a case report of a post-COVID-19 patient, who later developed severe PAP.
A 55-year-old male patient presented to the emergency department with progressive exertional dyspnea and hypoxia following a COVID-19 infection. Chest X-ray showed severe bilateral infiltrates. Patient received multiple courses of broad-spectrum antibiotics and prolonged course of corticosteroids without improvement. "Crazy paving" appearance in a follow up chest computed tomography raised the suspicion of PAP of what was initially thought to be a post-COVID-19 syndrome presentation. A diagnostic segmental bronchioalveolar lavage with a lung biopsy revealed a proteinaceous material filling the alveoli, with a positive periodic acid-Schiff (PAS) stain. Due to severe hypoxia, therapeutic segmental followed by whole lung lavage was performed with significant improvement.
Diagnosing PAP is challenging due to the rarity of the disease. An accurate diagnosis of PAP requires a combination of medical history, imaging, and bronchoalveolar lavage staining positive for PAS. Decision whether to treat with a segmental or whole lung lavage is individualized to each patient. Further studies are needed to confirm whether COVID-19 or long-term use of steroids might be contributing to PAP.
肺泡蛋白沉积症（PAP）是一种罕见的肺部疾病，主要表现为呼吸困难。由于2019冠状病毒病（COVID-19）感染与PAP的临床表现和影像学表现相似，在COVID-19感染背景下，PAP的诊断很容易被漏诊。我们报告一例COVID-19康复后患者，该患者后来发展为严重的PAP。
一名55岁男性患者在感染COVID-19后因进行性劳力性呼吸困难和低氧血症就诊于急诊科。胸部X线显示双侧严重浸润。患者接受了多疗程的广谱抗生素治疗和长时间的糖皮质激素治疗，但病情无改善。后续胸部计算机断层扫描显示的“铺路石征”使人们怀疑最初被认为是COVID-19后综合征表现的患者患有PAP。诊断性肺段支气管肺泡灌洗联合肺活检显示肺泡内充满蛋白质样物质，过碘酸希夫（PAS）染色阳性。由于严重低氧血症，进行了治疗性肺段灌洗，随后进行了全肺灌洗，病情显著改善。
由于PAP疾病罕见，其诊断具有挑战性。PAP的准确诊断需要结合病史、影像学检查以及PAS染色阳性的支气管肺泡灌洗结果。决定采用肺段灌洗还是全肺灌洗治疗需因人而异。需要进一步研究以确认COVID-19或长期使用类固醇是否可能导致PAP。
