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Autoimmune Pulmonary Alveolar Proteinosis That Improved after a COVID-19 Episode

Atsushi Yanagisawa1, Takayuki Takimoto1, Ryota Shintani1

  • 1Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan.

Internal Medicine (Tokyo, Japan)
|May 10, 2023
PubMed

Insights

Autoimmune pulmonary alveolar proteinosis (APAP) improved after a patient contracted coronavirus disease 2019 (COVID-19). This suggests COVID-19 may trigger immune responses that benefit APAP patients.

Area of Science:

  • Immunology
  • Pulmonology
  • Infectious Diseases

Background:

  • Autoimmune pulmonary alveolar proteinosis (APAP) results from anti-granulocyte-macrophage colony-stimulating factor (GM-CSF) autoantibodies, leading to macrophage dysfunction.
  • APAP management often involves whole-lung lavage (WLL) for severe cases with oxygenation issues and pulmonary shadows.

Observation:

  • A 77-year-old male APAP patient was evaluated for WLL due to worsening symptoms.
  • The patient contracted coronavirus disease 2019 (COVID-19) during his APAP assessment.
  • Following COVID-19 resolution, the patient exhibited significant improvement in oxygenation and pulmonary shadows.

Findings:

  • The patient's APAP symptoms substantially improved approximately three months post-COVID-19 infection.
  • WLL was successfully avoided due to the spontaneous resolution of APAP exacerbation.
  • A potential link between COVID-19-induced immunological reactions and APAP improvement was hypothesized.

Implications:

  • COVID-19 infection may induce beneficial immune responses in patients with autoimmune pulmonary alveolar proteinosis.
  • This case suggests a novel therapeutic avenue or understanding of APAP's natural course.
  • Further research is warranted to explore the immunomodulatory effects of COVID-19 on APAP.
Keywords:
coronavirus disease 2019 (COVID-19)granulocyte-macrophage colony-stimulating factor (GM-CSF)pulmonary alveolar proteinosisviral infection

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