Pulmonary alveolar proteinosis following cryptococcal meningitis: a possible cause?

Abstract : 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.
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https://hal-univ-lyon1.archives-ouvertes.fr/hal-02191903
Contributor : Marie-Gabrielle Chautard <>
Submitted on : Tuesday, July 23, 2019 - 4:57:56 PM
Last modification on : Wednesday, July 24, 2019 - 1:32:50 AM

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S. Demir, N. Chebib, F. Thivolet-Bejui, Vincent Cottin. Pulmonary alveolar proteinosis following cryptococcal meningitis: a possible cause?. BMJ Case Reports, 2018, 2018, ⟨10.1136/bcr-2017-222940⟩. ⟨hal-02191903⟩

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