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Rapidly Progressive Pulmonary Alveolar Proteinosis Following Cryptococcal Infection: Case Report and Literature

Samuel Cartmel Brookes1,2, Alexandra Sadler1, Alexander Troelnikov3,4,5

  • 1Department of Thoracic Medicine Royal Adelaide Hospital Adelaide South Australia Australia.

Respirology Case Reports
|February 11, 2025
PubMed

Insights

This case study highlights a rare instance of autoimmune pulmonary alveolar proteinosis (PAP) rapidly developing after cryptococcal infection in a young Aboriginal Australian woman. It emphasizes the need for prompt recognition and intervention for this severe respiratory condition.

Area of Science:

  • Pulmonary Medicine
  • Infectious Diseases
  • Immunology

Background:

  • Pulmonary alveolar proteinosis (PAP) is a rare lung disease characterized by surfactant accumulation in alveoli.
  • Cryptococcosis is a fungal infection often affecting the central nervous system and lungs.
  • Autoimmune PAP is linked to granulocyte-macrophage colony-stimulating factor antibodies, also associated with increased cryptococcosis risk.

Purpose of the Study:

  • To report a unique case of rapidly progressive autoimmune PAP following CNS cryptococcosis.
  • To underscore the importance of recognizing PAP in the Australian population.
  • To review the management and risks of bilateral whole lung lavage (WLL) in critically ill patients.

Main Methods:

  • Case report of a 24-year-old Aboriginal Australian woman.
  • Description of clinical presentation, diagnostic workup, and treatment.
  • Literature review on PAP and cryptococcal infections.

Main Results:

  • The patient presented with seizures due to CNS cryptococcosis, followed by rapid hypoxic respiratory failure from autoimmune PAP within weeks.
  • Urgent bilateral whole lung lavage (WLL) was performed while on venovenous-extracorporeal membrane oxygenation.
  • The case illustrates an unusually short interval between cryptococcal infection and PAP onset.

Conclusions:

  • Autoimmune PAP can develop rapidly after cryptococcosis, presenting a diagnostic and therapeutic challenge.
  • Bilateral WLL can be a critical intervention for severe PAP in ECMO-supported patients, despite associated risks.
  • Increased awareness of PAP, particularly in specific populations like Aboriginal Australians, is crucial.
Keywords:
Cryptococcus gattiicryptococcosisextracorporeal membrane oxygenationpulmonary alveolar proteinosiswhole lung lavage

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