[Multiple pulmonary nodules in an electric welder with recurrent fever]

This article reported a 33-year-old male electric welder with myelodysplastic syndrome (MDS) who presented with recurrent fever. Laboratory tests revealed anemia, thrombocytopenia, elevated inflammatory markers, and positive blood cultures. Chest imaging examinations showed diffuse miliary nodules in both lungs, enlarged mediastinal lymph nodes, and recurrent new patchy shadows in the lungs. Antibacterial treatment was ineffective. Through video-assisted thoracoscopic surgery and pathology, the patient was diagnosed with pulmonary iron dust deposition, lipoid pneumonia, pulmonary alveolar proteinosis (PAP) and secondary aspergillus infection. After antifungal and short-term antibacterial treatment, the patient's body temperature returned to normal. Considering the patient's overall condition, it is likely that MDS led to secondary PAP and lipoid pneumonia, and the decreased white blood cell function caused by MDS triggered subsequent pulmonary aspergillosis and bloodstream infections. This case highlighted the importance of considering potential hematological diseases in patients with complex pulmonary manifestations. At the same time, this case added to the limited real-world data on the relationship between MDS and PAP, particularly in patients with occupational exposures and concurrent infections.