Case Report: Whole lung lavage therapy for pulmonary alveolar proteinosis: a double-edged sword

Abstract

Pulmonary alveolar proteinosis (PAP) is an uncommon disease characterized by the excessive accumulation of lipoprotein material in the alveoli. No uniform treatment existed. However, whole lung lavage (WLL) remains the main treatment. We report the case of a 33-year-old non-smoking man, with no reported history of medical problems, who complained of dyspnea on exertion and cough for over 5 years. A CT scan revealed diffuse pulmonary interstitial infiltrates. Bronchoalveolar lavage was milky. WLL was planned, and the procedure was repeated 70 times and a total of 3,5 liters of saline serum was instilled and 2,8 liters of milky liquid was removed. The operation procedure was interrupted because of acute pulmonary edema. The patient was transferred to the intensive care unit for acute respiratory distress syndrome. He received 3 days of noninvasive ventilation and regression of supplemental oxygen.  Faced with the seriousness of the complication it was decided not to perform a third wash and to monitor the patient functionally and radiologically. Currently, after one year of the lung wash the patient is stable functionally and radiologically. We presented a rare complication of a WLL in a patient with PAP. Physicians should evaluate the patient carefully before suggesting WLL, which is an invasive procedure requiring general anesthesia for a pathology that may evolve spontaneously favorably.