[Alveolar lipoproteinosis treated by bronchopulmonary lavage]

Alveolar lipoproteinosis is a rare disease, a review of the Spanish Medical Index for 1971 to June 1994 showing only 9 reported cases. The intra-alveolar deposit of lipoprotein-type matter produces severe hypoxemia and favors infection by opportunistic germs. Treatment with massive bronchial lavage (MBL) removes the matter from the alveolar space, improves gas exchange and decreases the risk of infection. We report a case of primary alveolar lipoproteinosis treated with MBL in which the patient developed infections by Aspergillus fumigatus before lavage and after starting steroid treatment. The procedure was performed without complications, with significant clinical and gasometric improvement. The natural evolution of this disease is poorly understood. Spontaneous remissions have been observed, and as MBL is not a risk-free procedures, its use in treatment is controversial. We believe that when severe hypoxemia is present, MBL should be used early, when the risk is slight; MBL improves gas exchange and probably reduces the risk of opportunistic infection.