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Pulmonary Alveolar Proteinosis in Setting of Inhaled Toxin Exposure and Chronic Substance Abuse
Meirui Li1, Salem Alowami2, Miranda Schell2
1Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
Abstract:
Pulmonary alveolar proteinosis (PAP) is a rare lung disorder in which defects in alveolar macrophage maturation or function lead to the accumulation of proteinaceous surfactant in alveolar space, resulting in impaired gas exchange and hypoxemia. PAP is categorized into three types: hereditary, autoimmune, and secondary. We report a case of secondary PAP in a 47-year-old man, whose risk factors include occupational exposure to inhaled toxins, especially aluminum dust, the use of anabolic steroids, and alcohol abuse, which in mice leads to alveolar macrophage dysfunction through a zinc-dependent mechanism that inhibits granulocyte macrophage-colony stimulating factor (GM-CSF) receptor signalling. Although the rarity and vague clinical presentation of PAP can pose diagnostic challenges, clinician awareness of PAP risk factors may facilitate the diagnostic process and lead to more prompt treatment.
Insights
Pulmonary alveolar proteinosis (PAP) is a rare lung disease caused by surfactant buildup. This case highlights occupational toxins and substance abuse as potential risk factors for secondary PAP.
Area of Science:
- Pulmonary Medicine
- Toxicology
- Cell Biology
Background:
- Pulmonary alveolar proteinosis (PAP) is a rare lung disease characterized by surfactant accumulation in alveoli.
- It impairs gas exchange, leading to hypoxemia.
- PAP is classified into hereditary, autoimmune, and secondary types.
Observation:
- A case of secondary PAP in a 47-year-old man is presented.
- Risk factors included occupational exposure to aluminum dust, anabolic steroid use, and alcohol abuse.
- These factors may contribute to alveolar macrophage dysfunction.
Findings:
- Alveolar macrophage dysfunction, potentially via a zinc-dependent mechanism, was observed.
- This mechanism inhibits granulocyte-macrophage colony-stimulating factor (GM-CSF) receptor signaling.
- This leads to the characteristic surfactant accumulation in PAP.
Implications:
- The rarity and non-specific symptoms of PAP present diagnostic challenges.
- Increased clinician awareness of risk factors like toxin exposure and substance abuse is crucial.
- Prompt diagnosis facilitates timely treatment for secondary PAP.
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Assessment

