A case of development of autoimmune pulmonary alveolar proteinosis during the treatment of hypersensitivity pneumonitis

Maki Asami-Noyama; Kosuke Ito; Misa Harada; Yukari Hisamoto; Yoshie Kunihiro; Eiji Ikeda; Tasuku Yamamoto; Junki Suizu; Ayumi Fukatsu; Syuichiro Ohata; Yoriyuki Murata; Keiji Oishi; Yoshikazu Yamaji; Nobutaka Edakuni; Tomoyuki Kakugawa; Tsunahiko Hirano; Kazuto Matsunaga

Respiratory Medicine Case Reports (Jan 2023)

A case of development of autoimmune pulmonary alveolar proteinosis during the treatment of hypersensitivity pneumonitis

Maki Asami-Noyama,
Kosuke Ito,
Misa Harada,
Yukari Hisamoto,
Yoshie Kunihiro,
Eiji Ikeda,
Tasuku Yamamoto,
Junki Suizu,
Ayumi Fukatsu,
Syuichiro Ohata,
Yoriyuki Murata,
Keiji Oishi,
Yoshikazu Yamaji,
Nobutaka Edakuni,
Tomoyuki Kakugawa,
Tsunahiko Hirano,
Kazuto Matsunaga

Affiliations

Maki Asami-Noyama: Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Japan; Corresponding author. Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan.
Kosuke Ito: Department of Respiratory Medicine, National Hospital Organization Yamaguchi-Ube Medical Center, Ube, Japan
Misa Harada: Department of Respiratory Medicine, National Hospital Organization Yamaguchi-Ube Medical Center, Ube, Japan
Yukari Hisamoto: Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Japan
Yoshie Kunihiro: Department of Radiology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
Eiji Ikeda: Department of Pathology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
Tasuku Yamamoto: Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Japan
Junki Suizu: Department of Respiratory Medicine, National Hospital Organization Yamaguchi-Ube Medical Center, Ube, Japan
Ayumi Fukatsu: Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Japan
Syuichiro Ohata: Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Japan
Yoriyuki Murata: Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Japan
Keiji Oishi: Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Japan
Yoshikazu Yamaji: Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Japan
Nobutaka Edakuni: Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Japan
Tomoyuki Kakugawa: Department of Pulmonology and Gerontology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
Tsunahiko Hirano: Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Japan
Kazuto Matsunaga: Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Japan

Journal volume & issue: Vol. 44
p. 101862

Abstract

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Herein, we report the case of a 73-year-old woman with an occupational history of plaster grinding who developed autoimmune pulmonary alveolar proteinosis (PAP) during the treatment of fibrotic hypersensitivity pneumonitis with steroids and immunosuppressive drugs. Based on the changes in computed tomography imaging findings, poor response to steroid therapy, and markedly elevated KL-6 levels, PAP was suspected and diagnosed by bronchoscopy. Repeated segmental bronchoalveolar lavage under high-flow nasal cannula oxygen therapy resulted in slight improvement. Steroids and immunosuppressive treatments for other interstitial lung diseases may cause PAP or exacerbate latent PAP.

Published in Respiratory Medicine Case Reports

ISSN: 2213-0071 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the respiratory system
Website: http://www.journals.elsevier.com/respiratory-medicine-case-reports/

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