Exacerbation of autoimmune pulmonary alveolar proteinosis that improved with lone treatment of complicating nontuberculous mycobacterial infection: A case report

Shunya Shiohira; Masashi Sakayori; Keiichiro Yoshioka; Hajime Kasai; Ryutaro Hirama; Mitsuhiro Abe; Hiroki Nishimura; Takuji Suzuki

doi:10.1016/j.rmcr.2021.101521

Exacerbation of autoimmune pulmonary alveolar proteinosis that improved with lone treatment of complicating nontuberculous mycobacterial infection: A case report

Respir Med Case Rep. 2021 Sep 27:34:101521. doi: 10.1016/j.rmcr.2021.101521. eCollection 2021.

Authors

Shunya Shiohira¹, Masashi Sakayori², Keiichiro Yoshioka², Hajime Kasai^{2

3}, Ryutaro Hirama², Mitsuhiro Abe², Hiroki Nishimura⁴, Takuji Suzuki²

Affiliations

¹ Department of Medicine, School of Medicine, Chiba University, Chiba, 260-8670 Japan.
² Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan.
³ Health Professional Development Center, Chiba University Hospital, Chiba, 260-8670, Japan.
⁴ Department of Respiratory Medicine, National Hospital Organization Chiba Medical Center, Chiba, 260-0042, Japan.

Abstract

Herein, we present the case of a 63-year-old man with autoimmune pulmonary alveolar proteinosis (APAP) complicated by Mycobacterium avium complex (MAC) infection. APAP was diagnosed based on serum anti-granulocyte-macrophage colony-stimulating factor antibody, bronchoalveolar lavage fluid (BALF) findings, and transbronchial lung biopsy. Nodular shadows with cavities were visible on chest CT images, and Mycobacterium intracellulare was identified by BALF culture. Rifampicin, ethambutol, and clarithromycin were administered, and 4 months later, the nodular shadows of MAC had disappeared, and APAP was remarkably improved. Thus, in cases of APAP exacerbation complicated with infections, such as MAC, control of the infections may improve APAP.

Keywords: Antibiotics; Exacerbation; Mycobacterium avium complex; Pulmonary alveolar proteinosis.

Publication types

Case Reports