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Mejri I, Ben Hmida L, Kacem M, Msalmani M, Snène H, Blibech H, Ayadi A, Zaouali J, Moatemri Z. Case Report: The first reported case of pulmonary alveolar proteinosis with myasthenia gravis in a 27-year-old patient. F1000Res 2023; 11:1439. [PMID: 38779463 PMCID: PMC11109554 DOI: 10.12688/f1000research.127299.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 05/25/2024] Open
Abstract
Background: Pulmonary alveolar proteinosis is a very rare diffuse lung disease characterized by the accumulation of amorphous and periodic acid Schiff-positive lipoproteinaceous material in the alveolar spaces due to impaired surfactant clearance by alveolar macrophages. Three main types were identified: Autoimmune, secondary and congenital. Pulmonary alveolar proteinosis has been previously reported to be associated with several systemic auto-immune diseases. Accordingly, we present the first case report of pulmonary alveolar proteinosis associated with myasthenia gravis. Case: A 27-year-old female patient, ex-smoker, developed a dyspnea on exertion in 2020. The chest X-ray detected diffuse symmetric alveolar opacities. Pulmonary infection was ruled out, particularly COVID-19 infection. The chest scan revealed the "crazy paving" pattern. The bronchoalveolar lavage showed a rosy liquid with granular acellular eosinophilic material Periodic acid-Schiff positive. According to the lung biopsy results, she was diagnosed with pulmonary alveolar proteinosis. The granulocyte macrophage colony-stimulating factor autoantibodies were negative. Nine months later, she was diagnosed with bulbar seronegative myasthenia gravis, confirmed with the electroneuromyography with repetitive nerve stimulation showing significant amplitude decrement of the trapezius and spinal muscles. She was treated with pyridostigmine, oral corticosteroids and azathioprine. Given the worsening respiratory condition of the patient, a bilateral whole lung lavage was performed with a partial resolution of symptoms. Thus, this previously unreported association was treated successfully with rituximab, including improvement of dyspnea, diplopia and muscle fatigability at six months of follow-up. Conclusions: This case emphasizes on the possible association of auto-immune disease to PAP, which could worsen the disease course, as the specific treatment does not exist yet. Hence, further studies are needed to establish clear-cut guidelines for PAP management, particularly when associated to auto-immune diseases.
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Affiliation(s)
- Islam Mejri
- Pneumology Department, Military Hospital of Tunis, Montfleury, Tunis, 1008, Tunisia
| | - Lenda Ben Hmida
- Pneumology Department, Military Hospital of Tunis, Montfleury, Tunis, 1008, Tunisia
| | - Maroua Kacem
- Pneumology Department, Military Hospital of Tunis, Montfleury, Tunis, 1008, Tunisia
| | - Mariem Msalmani
- Neurology Department, Military Hospital of Tunis, Montfleury, Tunis, 1008, Tunisia
| | - Houda Snène
- Pneumology Department, Mongi Slim Hospital, La Marsa, Tunis, 2070, Tunisia
| | - Hana Blibech
- Pneumology Department, Mongi Slim Hospital, La Marsa, Tunis, 2070, Tunisia
| | - Aida Ayadi
- Pathology Department, Abderrahmen Mami Hospital, Ariana, 2080, Tunisia
| | - Jamel Zaouali
- Neurology Department, Military Hospital of Tunis, Montfleury, Tunis, 1008, Tunisia
| | - Zied Moatemri
- Pneumology Department, Military Hospital of Tunis, Montfleury, Tunis, 1008, Tunisia
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Wang L, Fan J, Zheng L, Chen L. Efficacy and Safety of Iclaprim for the Treatment of Skin Structures and Soft Tissue Infections: A Methodological Framework. Front Pharmacol 2022; 13:932688. [PMID: 35928265 PMCID: PMC9344044 DOI: 10.3389/fphar.2022.932688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Skin and soft tissue infections (SSTIs) are among the most common infections worldwide. They manifest in a variety of forms, such as erysipelas, cellulitis, and necrotizing fasciitis. Antibiotics are the significant method for clinical treatment of SSTIs. This study reported a methodology framework to determine the efficacy and safety of iclaprim in treatment of SSTIs.Methods: We will search the PubMed, EMbase, CNKI, WanFang Data, VIP, and ClinicalTrials.gov from their inception to June 2022 for randomized controlled trials and cohort studies on iclaprim with SSTIs. Two authors will independently screen the eligible studies, assess the quality of the included papers, and extract the required information. Randomized controlled trials will be assessed using the Cochrane risk-of-bias tool. The Newcastle–Ottawa Scale will be used to evaluate observational studies. The quality of the evidence will be evaluated using the Grading of Recommendations Assessment Development and Evaluation system. RevMan 5.3 will be used for the data synthesis and quantitative analysis.Results and Discussions: This study will provide the clinicians with more high-quality evidence to choose iclaprim for patients with SSTIs.Ethics and Dissemination: This systematic review and meta-analysis will be based on published data, so ethical approval is not necessary. The results of this meta-analysis will be published in a peer-reviewed journal.
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Affiliation(s)
- Lian Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Jin Fan
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Linli Zheng
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Lingmin Chen
- Department of Anesthesiology and National Clinical Research Center for Geriatrics, The Research Units of West China (2018RU012, Chinese Academy of Medical Sciences), West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Lingmin Chen,
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