A Challenging Case of Influenza H1N1 Pneumonia and Pulmonary Alveolar Protienosis, Comprehensive Discussion of Disease-Disease Relationship in Terms of Causality, Cross-Reactivity, Outcome and Effect of Treatment
Pulmonary alveolar proteinosis (PAP) is a rare lung condition in which amorphous lipoproteinaceous material accumulates in the distal air gaps as a result of alveolar macrophages’ failure to remove surfactant. This results in poor gas exchange and various degrees of arterial hypoxemia. Despite the fact that autoimmune PAP is assumed to be idiopathic, this focused analysis examines the possible link between viral pneumonia and autoimmune PAP (APAP) in terms of pathogenesis, superinfection, and therapeutic effects. The confirmed serum anti-granulocyte macrophage-colony stimulating factor (GM-CSF) antibody is a putative viral aetiology “trigger” for a newly diagnosed case of APAP. This is the first report that we are aware of that describes and discusses this issue. For more than 4 months, the patient, a 38-year-old ex-smoker, had increasingly worsening dyspnea and a chronic, severe cough. It was assumed to be a case of community-acquired pneumonia (CAP), and she was treated with numerous antibiotics, but her condition did not improve. Despite considerable alveolar filling on chest X-ray, physical examination revealed mild hypoxia and modest bilateral fine crepitations (CXR). PAP was discovered during a bronchoscopic surgery. During the course of the disease, the patient experienced an abrupt flare-up of the condition, which was caused by a confirmed H1N1 influenza infection. In the case of recurrent pneumonia that does not respond to treatment, APAP should be investigated. In this case report, we propose that viral causal “triggers” or cross-reactivity of GM-CSF antibodies may play a role in the development of APAP. We also go over the care that was delivered, the antiviral therapy response, and the diagnostic and management issues that were faced during the follow-up.
Author (S) Details
Saeed Mishal Albogami
Respirology Division, Department of Medicine, King Fahad Hospital, Rabigh Medical College, King Abdulaziz University, Jeddah, Saudi Arabia.
Abdelfattah A. Touman
Pulmonology Section, Department of Medicine, Mouwasat Hospital, Dammam, Saudi Arabia.
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