COVID-19 and severe pulmonary alveolar proteinosis (PAP): A case report
Background: 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...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-07-01
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| Series: | Heliyon |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405844023053070 |
| _version_ | 1797771427309420544 |
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| author | Ahmad Basim Melhem Abdelsamea Mohammed Seif Omar Husni Omar Samir Al Bashir Shaher M. Samrah |
| author_facet | Ahmad Basim Melhem Abdelsamea Mohammed Seif Omar Husni Omar Samir Al Bashir Shaher M. Samrah |
| author_sort | Ahmad Basim Melhem |
| collection | DOAJ |
| description | Background: 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. Case presentation: 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. Conclusion: 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. |
| first_indexed | 2024-03-12T21:37:25Z |
| format | Article |
| id | doaj.art-55f04e276b8a4fdb8a5ab5b963f19b41 |
| institution | Directory Open Access Journal |
| issn | 2405-8440 |
| language | English |
| last_indexed | 2024-03-12T21:37:25Z |
| publishDate | 2023-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heliyon |
| spelling | doaj.art-55f04e276b8a4fdb8a5ab5b963f19b412023-07-27T05:58:32ZengElsevierHeliyon2405-84402023-07-0197e18099COVID-19 and severe pulmonary alveolar proteinosis (PAP): A case reportAhmad Basim Melhem0Abdelsamea Mohammed Seif1Omar Husni Omar2Samir Al Bashir3Shaher M. Samrah4Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, PO Box: 630001, Irbid, 22110, JordanDepartment of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, PO Box: 630001, Irbid, 22110, JordanDepartment of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, PO Box: 630001, Irbid, 22110, JordanDepartment of Pathology and Microbiology, Faculty of Medicine, Jordan University of Science and Technology, PO Box: 630001, Irbid, 22110, JordanDepartment of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, PO Box: 630001, Irbid, 22110, Jordan; Corresponding author.Background: 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. Case presentation: 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. Conclusion: 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.http://www.sciencedirect.com/science/article/pii/S2405844023053070Pulmonary alveolar proteinosisCOVID-19Bronchioalveolar lavage |
| spellingShingle | Ahmad Basim Melhem Abdelsamea Mohammed Seif Omar Husni Omar Samir Al Bashir Shaher M. Samrah COVID-19 and severe pulmonary alveolar proteinosis (PAP): A case report Heliyon Pulmonary alveolar proteinosis COVID-19 Bronchioalveolar lavage |
| title | COVID-19 and severe pulmonary alveolar proteinosis (PAP): A case report |
| title_full | COVID-19 and severe pulmonary alveolar proteinosis (PAP): A case report |
| title_fullStr | COVID-19 and severe pulmonary alveolar proteinosis (PAP): A case report |
| title_full_unstemmed | COVID-19 and severe pulmonary alveolar proteinosis (PAP): A case report |
| title_short | COVID-19 and severe pulmonary alveolar proteinosis (PAP): A case report |
| title_sort | covid 19 and severe pulmonary alveolar proteinosis pap a case report |
| topic | Pulmonary alveolar proteinosis COVID-19 Bronchioalveolar lavage |
| url | http://www.sciencedirect.com/science/article/pii/S2405844023053070 |
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