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CASE REPORT
Pulmonary alveolar proteinosis following cryptococcal meningitis: a possible cause?
  1. Sarah Demir1,
  2. Nader Chebib1,
  3. Francoise Thivolet-Bejui2,
  4. Vincent Cottin1,3
  1. 1 Department of Pneumology, Hospices Civils de Lyon, National Reference Center for Rare Pulmonary Diseases, Lyon, France
  2. 2 Department of Pathology, Hopital Cardio-Vasculaire et Pneumologique Louis Pradel, Lyon, France
  3. 3 Claude Bernard Lyon 1 University, University of Lyon, INRA, UMR754, Lyon, France
  1. Correspondence to Professor Vincent Cottin, vincent.cottin{at}chu-lyon.fr

Summary

Autoimmune pulmonary alveolar proteinosis (PAP) is a rare interstitial lung disease characterised by the presence of granulocyte macrophage colony-stimulating factor (GM-CSF) autoantibodies. A man with no history of infection developed cryptococcal meningitis and a right parahilar cryptococcal mass. Antifungal treatment led to infection control, although there was presence of neurological sequelae. After 3 years, thoracic CT revealed bilateral ground glass opacities and a crazy paving pattern. Transparietal needle biopsy showed proteinaceous alveolar deposits, confirming the diagnosis of PAP. A high titre of serum anti-GM-CSF autoantibodies was found. No specific treatment was started, and radiological lesions decreased progressively. Cryptococcal infection may occur in PAP and in patients with anti-GM-CSF antibodies without PAP. These antibodies dysregulate phagocytosis in monocytes and macrophages, possibly leading to opportunistic infections in previously healthy subjects.

  • meningitis
  • interstitial lung disease
  • immunology
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Footnotes

  • Contributors VC: conception and design of the article. SD, NC: figure preparation. SD: data extraction. VC, SD, NC, FT-B: data analysis and acquisition. All authors edited and revised the manuscript. All authors approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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