1
|
Zhang FZ, Yuan JX, Qin L, Tang LF. Pulmonary Alveolar Proteinosis Due to Pneumocystis carinii in Type 1 Hyper-IgM Syndrome: A Case Report. Front Pediatr 2020; 8:264. [PMID: 32596190 PMCID: PMC7301693 DOI: 10.3389/fped.2020.00264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/27/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Pulmonary alveolar proteinosis (PAP) is a rare diffuse lung disease. Reports of rare cases of PAP due to Pneumocystis jirovecii (P. jirovecii) exist in infants with immunodeficiency diseases, but no cases have been reported to date in pediatric patients with type 1 hyper-IgM syndrome (HIGM1). Case Presentation: Herein, we present a case of PAP secondary to P. jirovecii on an infant with HIGM1. He was admitted to our unit because of cough and tachypnea. Lung biopsy confirmed the diagnosis of PAP, whereas hexamine-silver staining of the bronchoalveolar lavage fluid identified P. jirovecii infection. No other probable cause of PAP was observed. Whole exome sequencing indicated a novel c.511dupA (p.I171N*30) hemizygous mutation in the CD40 ligand (CD40LG) gene. He was cured with bronchoalveolar lavage and compound sulfamethoxazole tablets. Conclusions: To our knowledge, this is the first reported case of P. jirovecii infection as a reversible cause of PAP in an infant with HIGM1.
Collapse
Affiliation(s)
- Fei Zhou Zhang
- Department of Pneumology, Zhejiang University School of Medicine of Children's Hospital, Hangzhou, China
| | - Jie Xin Yuan
- Department of Pneumology, Zhejiang University School of Medicine of Children's Hospital, Hangzhou, China
| | - Lu Qin
- Department of Pneumology, Zhejiang University School of Medicine of Children's Hospital, Hangzhou, China
| | - Lan Fang Tang
- Department of Pneumology, Zhejiang University School of Medicine of Children's Hospital, Hangzhou, China
| |
Collapse
|
2
|
Kolls JK. An Emerging Role of B Cell Immunity in Susceptibility to Pneumocystis Pneumonia. Am J Respir Cell Mol Biol 2018; 56:279-280. [PMID: 28248133 DOI: 10.1165/rcmb.2016-0360ed] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Jay K Kolls
- 1 Richard King Mellon Institute for Pediatric Research Department of Pediatrics and.,2 University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania
| |
Collapse
|
3
|
Tanaka-Kubota M, Shinozaki K, Miyamoto S, Yanagimachi M, Okano T, Mitsuiki N, Ueki M, Yamada M, Imai K, Takagi M, Agematsu K, Kanegane H, Morio T. Hematopoietic stem cell transplantation for pulmonary alveolar proteinosis associated with primary immunodeficiency disease. Int J Hematol 2017; 107:610-614. [PMID: 29185156 DOI: 10.1007/s12185-017-2375-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 11/23/2017] [Accepted: 11/24/2017] [Indexed: 01/27/2023]
Abstract
Pulmonary alveolar proteinosis (PAP) is a rare disorder that is characterized by the excessive accumulation of surfactant-like materials in the alveoli, leading to hypoxemic respiratory failure. We describe two Japanese infants with PAP associated with hypogammaglobulinemia and monocytopenia. These patients may have underlying primary immunodeficiency (PID) and were successfully treated with allogeneic hematopoietic stem cell transplantation (HSCT). This report indicates that allogeneic HSCT may provide a curative treatment for PAP associated with PID.
Collapse
Affiliation(s)
- Mari Tanaka-Kubota
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Koji Shinozaki
- Department of Pediatrics, School of Medicine, Shinshu University, Matsumoto, Japan
| | - Satoshi Miyamoto
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Masakatsu Yanagimachi
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Tsubasa Okano
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Noriko Mitsuiki
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Masahiro Ueki
- Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Masafumi Yamada
- Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kohsuke Imai
- Department of Community Pediatrics, Perinatal and Maternal Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Masatoshi Takagi
- Department of Community Pediatrics, Perinatal and Maternal Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kazunaga Agematsu
- Department of Pediatrics, School of Medicine, Shinshu University, Matsumoto, Japan.,Department of Infection and Host Defense, Graduate School of Medicine, Shinshu University, Matsumoto, Japan
| | - Hirokazu Kanegane
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Tomohiro Morio
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| |
Collapse
|
4
|
Hadda V, Tiwari P, Madan K, Mohan A, Gupta N, Bharti SJ, Kumar V, Garg R, Trikha A, Jain D, Arava S, Khilnani GC, Guleria R. Pulmonary alveolar proteinosis: Experience from a tertiary care center and systematic review of Indian literature. Lung India 2016; 33:626-634. [PMID: 27890991 PMCID: PMC5112819 DOI: 10.4103/0970-2113.192876] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Pulmonary alveolar proteinosis (PAP) is a rare disorder characterized by deposition of lipoproteinaceous material within alveoli, with a variable clinical course. Here, we report an experience of management of PAP at our center. A systematic review of previously reported cases from India is also included in the article. MATERIALS AND METHODS This study included patients with primary PAP managed at our center from 2009 to 2015. Diagnosis of primary PAP was based on histopathologic diagnosis on bronchoalveolar lavage or transbronchial lung biopsy and absence of causes of secondary PAP. For systematic review of Indian publications, the literature search was performed using PubMed and EMBASE databases using the terms "pulmonary alveolar proteinosis'" or "alveolar proteinosis" and "India" or "Indian." RESULTS During the above-specified period, five patients with diagnosis of PAP were admitted at our center. Median age of patients was 32 years (interquartile range [IQR] 30.5-59); 80% were female. Mean duration (± standard deviation) of symptoms was 6.2 (±1.79) months. Anti-granulocyte-macrophage colony stimulating factor (GM-CSF) antibodies were elevated in 4 out of 5 patients (80%). For management, whole lung lavage (WLL) was done for four patients with median volume of 32.5 (IQR 18-74) L per patient. All the patients showed significant symptomatic as well as improvement in physiological parameters. Subcutaneous GM-CSF and ambroxol were given to 3 patients and 1 patient, respectively. The median follow-up of all patients was 18 (IQR 5-44) months. A systematic review of all Indian studies of PAP revealed thirty publications. CONCLUSIONS WLL is the most common, effective, and safe therapy in patients with PAP. GM-CSF administration is an efficacious treatment for patients with incomplete response after WLL.
Collapse
Affiliation(s)
- Vijay Hadda
- Department of Pulmonary Medicine and Sleep Disorders, All Institute of Medical Sciences, New Delhi, India
| | - Pawan Tiwari
- Department of Pulmonary Medicine and Sleep Disorders, All Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary Medicine and Sleep Disorders, All Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary Medicine and Sleep Disorders, All Institute of Medical Sciences, New Delhi, India
| | - Nishkarsh Gupta
- Department of Anaesthesiology, All Institute of Medical Sciences, New Delhi, India
| | | | - Vinod Kumar
- Department of Anaesthesiology, All Institute of Medical Sciences, New Delhi, India
| | - Rakesh Garg
- Department of Anaesthesiology, All Institute of Medical Sciences, New Delhi, India
| | - Anjan Trikha
- Department of Anaesthesiology, All Institute of Medical Sciences, New Delhi, India
| | - Deepali Jain
- Department of Pathology, All Institute of Medical Sciences, New Delhi, India
| | - Sudheer Arava
- Department of Pathology, All Institute of Medical Sciences, New Delhi, India
| | - Gopi C Khilnani
- Department of Pulmonary Medicine and Sleep Disorders, All Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary Medicine and Sleep Disorders, All Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
5
|
Kunal S, Gera K, Pilaniya V, Jain S, Gothi R, Shah A. "Crazy-paving" pattern: A characteristic presentation of pulmonary alveolar proteinosis and a review of the literature from India. Lung India 2016; 33:335-42. [PMID: 27186004 PMCID: PMC4857576 DOI: 10.4103/0970-2113.180936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Shekhar Kunal
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Kamal Gera
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Vikas Pilaniya
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Sudhir Jain
- Department of Pathology, Oncquest Laboratories Limited, New Delhi, India
| | - Rajesh Gothi
- Department of Radiology and Imaging, Saket City Hospital, New Delhi, India
| | - Ashok Shah
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| |
Collapse
|
6
|
Vece TJ, Young LR. Update on Diffuse Lung Disease in Children. Chest 2016; 149:836-45. [PMID: 26502226 DOI: 10.1378/chest.15-1986] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 09/22/2015] [Accepted: 10/04/2015] [Indexed: 12/31/2022] Open
Abstract
Diffuse lung diseases in children, also called children's interstitial lung disease, are a diverse group of rare disorders that cause disturbances of gas exchange in the lungs. Although individually rare, there are many different forms of diffuse lung disease in children, and collectively these disorders are associated with significant morbidity and mortality, as well as health-care resource utilization. Over the past several years, there have been many significant advances in the field, including genetic discoveries and the development of clinical practice guidelines. This review summarizes recent advances in the understanding, diagnosis, and treatment of diffuse lung diseases in children.
Collapse
Affiliation(s)
- Timothy J Vece
- Section of Pulmonology, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
| | - Lisa R Young
- Pulmonary Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN; Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|