Multifarious Relationship between Tuberculosis and Pulmonary Alveolar Proteinosis
Bronchoalveolar lavage cytological study with clinicopathological correlation
Keywords:
Pulmonary alveolar proteinosis, bronchoalveolar lavage, tuberculosis
Abstract
Background: Pulmonary alveolar proteinosis (PAP) is a rare disorder which is categorized into congenital, idiopathic and secondary types. There is a marked paucity of literature from the Indian subcontinent that analyses the causation of PAP. Methods: We studied clinical features, histopathological findings and cytological features in 19 bronchoalveolar lavage (BAL) cytology confirmed cases of PAP diagnosed over a 28-year period. Results: One or more risk factors for PAP were noted in 11 cases (57.89%) and included exposure to silica dust, chemicals, smoke and flour, immunological diseases, tuberculosis, retroviral disease and monoclonal gammopathy. Three patients had more than one risk factor. Only one patient was tested for anti-granulocyte-monocyte colony-stimulating-factor (anti-GM-CSF) antibodies. Elevated anti-GM-CSF antibodies and absence of an identifiable risk factor was noted in this patient. Super-infection was noted in three (15.79%); with tuberculosis in two and aspergillosis in one. Six patients had a recent past history of anti-tuberculosis therapy but only one among them had documented acid fast bacilli positivity confirming tuberculosis and autopsy revealed tuberculosis in one patient. Conclusion: The present study observed that a considerable proportion of cases were associated with known risk factors for PAP. A variable relationship of PAP and tuberculosis was observed where the latter was noted as a possible risk factor, a co-existing disease at presentation, a superinfection, or even a possible cause of a misdiagnosis of PAP as tuberculosis. These findings are of great relevance in view of the endemicity of tuberculosis in India.References
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11. Hwang JA, Song JH, Kim JH, Chung MP, Kim DS, Song JW, Kim YW, Choi SM, et al. Clinical significance of cigarette smoking and dust exposure in pulmonary alveolar proteinosis: a Korean national survey. BMC Pulmonary Medicine 2017;17:147
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13. ReyesJM, Putong PB. Association of pulmonary alveolar lipoproteinosis with mycobacterial infection. Am J Clin Pathol 1980;74:478-85.
14. Pereira-Silva J.L., Marinho M.M.M.A., Veloso T.V.B. and Coelho Filho J.C. Pulmonary Alveolar Proteinosis and Tuberculosis in a Diabetic Patient: A Rare or a Seldom Diagnosed Association? The Brazilian Journal of Infectious Diseases2002;6:188-195.
15. Tekgül S, Bilaceroglu S, Ozkaya S, Coskun A, Komurcuoglu B, Cirak AK. Pulmonary alveolar proteinosis and superinfection with pulmonary tuberculosis in a case. Respiratory Medicine Case Reports 2012;5:25-28.
16. Fildan Ap, Toma Cl, Tofolean D, Bălteanu M, Danteş E. Overlapping Tuberculosis In A Patient With Pulmonary Alveolar Proteinosis. Acta Medica Mediterranea, 2016;32:1597.
17. Kotov PV, Shidham VB. Alveolar proteinosis in a patient recovering from Pneumocystis carinii infection: a case report with a review of literature.CytoJournal 2006;3:22
18. Chaudhuri R, Prabhudesai P, Vaideeswan V, Mahashur AA. Pulmonary Alveolar Proteinosis With Pulmonary Tuberculosis. Ind. J. Tub. 1996;43:27-29.
19. Baldi, MM, Nair, J, Athavale, A, Gavali, V, Sarkar M, Divate S, and Shah U. Serial Lobar Lung Lavage in Pulmonary Alveolar Proteinosis. J Bronchol Intervent Pulmonol 2013;20:333–337.
2. Inoue Y, Trapnell BC, Tazawa R, Arai T, Takada T, Hizawa N, Kasahara Y, Tatsumi K. et al. Characteristics of a Large Cohort of Patients with Autoimmune Pulmonary Alveolar Proteinosis in Japan. Am J Respir Crit Care Med 2008;177:752-62.
3. Ioachimescu OC and Kavuru MS. Pulmonary alveolar proteinosis. Chronic Respiratory Disease 2006;3:149-159
4. Mikami, T., Yamamoto, Y., Yokoyama, M., Okayasu I. Pulmonary alveolar proteinosis: diagnosis using routinely processed smears of bronchoalveolar lavage fluid. J Clin Pathol 1997;50:981-984
5. Main, S., Somani, V., Molyneux, A, Bhattacharya, M., Randhawa R. Kavidasan, A. Unsuspected pulmonary alveolar proteinosis in a patient with a slow resolving pneumonia: A case report. Respiratory Medicine Case Reports 2013;10:1-3.
6. Baro A, Shah I, Chandane P, Khosla I. Pulmonary alveolar proteinosis in a 10-year-old girl masquerading as tuberculosis. Oxford Medical Case Reports 2015,6:300–302.
7. Hadda V, Tiwari P, Madan K, Mohan A, Gupta N, Bharti SJ, Kumar V, Garg R, et al. Pulmonary alveolar proteinosis: Experience from a tertiary care center and systematic review of Indian literature. Lung India 2016;33:626–634.
8. Suzuki, T., Trapnell, B. C. Pulmonary Alveolar Proteinosis Syndrome. Clin Chest Med 2016;37:431–440.
9. Griese M. Pulmonary Alveolar Proteinosis: A Comprehensive Clinical Perspective. Pediatrics 2017;140:e20170610
10. Zhang, D., Tian, X., Feng, R., Guo, X., Wang, P., Situ, Y., Xiao, Y., Kai-Feng Xu K-F. Secondary pulmonary alveolar proteinosis: a single-center retrospective study (a case series and literature review). BMC Pulmonary Medicine 2018;18:15-21.
11. Hwang JA, Song JH, Kim JH, Chung MP, Kim DS, Song JW, Kim YW, Choi SM, et al. Clinical significance of cigarette smoking and dust exposure in pulmonary alveolar proteinosis: a Korean national survey. BMC Pulmonary Medicine 2017;17:147
12. Ramirez J. Pulmonary alveolar proteinosis. Treatment in a case complicated by tuberculosis. Am Rev Respir Dis 1967;95:491-5.
13. ReyesJM, Putong PB. Association of pulmonary alveolar lipoproteinosis with mycobacterial infection. Am J Clin Pathol 1980;74:478-85.
14. Pereira-Silva J.L., Marinho M.M.M.A., Veloso T.V.B. and Coelho Filho J.C. Pulmonary Alveolar Proteinosis and Tuberculosis in a Diabetic Patient: A Rare or a Seldom Diagnosed Association? The Brazilian Journal of Infectious Diseases2002;6:188-195.
15. Tekgül S, Bilaceroglu S, Ozkaya S, Coskun A, Komurcuoglu B, Cirak AK. Pulmonary alveolar proteinosis and superinfection with pulmonary tuberculosis in a case. Respiratory Medicine Case Reports 2012;5:25-28.
16. Fildan Ap, Toma Cl, Tofolean D, Bălteanu M, Danteş E. Overlapping Tuberculosis In A Patient With Pulmonary Alveolar Proteinosis. Acta Medica Mediterranea, 2016;32:1597.
17. Kotov PV, Shidham VB. Alveolar proteinosis in a patient recovering from Pneumocystis carinii infection: a case report with a review of literature.CytoJournal 2006;3:22
18. Chaudhuri R, Prabhudesai P, Vaideeswan V, Mahashur AA. Pulmonary Alveolar Proteinosis With Pulmonary Tuberculosis. Ind. J. Tub. 1996;43:27-29.
19. Baldi, MM, Nair, J, Athavale, A, Gavali, V, Sarkar M, Divate S, and Shah U. Serial Lobar Lung Lavage in Pulmonary Alveolar Proteinosis. J Bronchol Intervent Pulmonol 2013;20:333–337.
Published
2020-01-30
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