Pulmonary alveolar proteinosis complicated by pulmonary and intracranial cryptococcal infection: A case report.

RATIONALE

Pulmonary alveolar proteinosis (PAP) is a rare interstitial lung disease. Superimposed opportunistic Cryptococcus gattii infection can significantly complicate clinical management.

PATIENT CONCERNS

A 34-year-old male patient presented to the respiratory department with a paroxysmal cough for 2 months.

DIAGNOSES

Typical computed tomography manifestation and lung biopsy were consistent with PAP. Culture of lung lavage fluid, cerebrospinal fluid, and targeted next-generation sequencing of lung tissue revealed Cryptococcus infection.

INTERVENTIONS

Amphotericin B, fluconazole, and flucytosine were used for induction therapy. Right lower lobectomy combined with postoperative voriconazole was continued.

OUTCOMES

The CSF cryptococcal antigen titer has declined, and brain MRI shows a reduction in lesions. The clinical course is now stable and improving.

LESSONS

Patients with PAP may have relatively rare opportunistic infections. Multifaceted examinations are very necessary for the diagnosis of C. gattii. During the treatment of C. gattii, great attention should be paid to possible adverse reactions such as liver and kidney damage and thrombosis.