OVERLAPPING TUBERCULOSIS IN A PATIENT WITH PULMONARY ALVEOLAR PROTEINOSIS

ARIADNA PETRONELA FILDAN*, CLAUDIA LUCIA TOMA**, DOINA TOFOLEAN*, MARA BĂLTEANU***, ELENA DANTEŞ****

* Department of Internal Medicine, Faculty of Medicine, ”Ovidius” University, Constanţa, Romania - **”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania, “Marius Nasta” Institute of Pneumology, Bucharest, Romania - ****“Marius Nasta” Institute of Pneumology, Bucharest, Romania - Elena Danteş - ***Department of Pneumophtysiology, Faculty of Medicine, ”Ovidius” University, Constanţa, Romania

Introduction: Pulmonary alveolar proteinosis (PAP) is a rare disease of unknown origin, characterized by impaired surfactant metabolism that leads to abnormal accumulation of amorphous phospholipoprotein material in the alveoli. The association between PAP and tuberculosis (TB) has been rarely reported.

Case presentation: We present the case of a 33 year-old man diagnosed with PAP and complicated with pulmonary TB. The suspicion of PAP was based on chest computed tomography with “crazy-paving” pattern, and the diagnosis was sustained by eosinophilic PAS (Periodic acid-Schiff) positive lipoproteinaceous material in bronchoalveolar lavage fluid. Two procedures of wholelung therapeutic lavage were performed with good clinical results. Three years after PAP diagnosis, the patient was diagnosed with TB (bronchial aspirate smears and culture were positive for Mycobacterium tuberculosis).

Conclusion: Pulmonary TB may occur as a complication in an idiopathic PAP due to reduced phagocytic and chemotaxis capacity of alveolar macrophages or as a possible nosocomial Mycobacterium tuberculosis transmission by periodic bronchoscopy exams and washings.