1
|
Mardani P, Naseri R, Shahriarirad R, Mahram H, Shafi M, Niknam T, Khosravi MB, Fallahi MJ, Amirian A. Successful bilateral lung transplantation in pulmonary alveolar microlithiasis: A case report and review of literature. THE CLINICAL RESPIRATORY JOURNAL 2024; 18:e13773. [PMID: 38725329 PMCID: PMC11082537 DOI: 10.1111/crj.13773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 03/11/2024] [Accepted: 04/19/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Pulmonary alveolar microlithiasis (PAM) is a rare autosomal recessive genetic disorder with approximately 1000 known cases worldwide, in which calcium phosphate microliths deposit in the alveolar air spaces. As of writing this report, no definitive conventional therapy exists, and many PAM cases may progress to severe respiratory failure and potential death. Bilateral lung transplantation (BLx) seems to be the most optimal solution; however, this procedure is challenging along with limited reports regarding the outcome in PAM. We report a case of PAM successfully treated with BLx for the first time in Iran. METHOD We present the case of a 42-year-old female with a longstanding history of cough, not responding to conventional antitussive medication, who was diagnosed as a case of PAM following a hospitalization due to coughing, dyspnea on exertion, and hemoptysis. Despite treatment with corticosteroid and medical treatment, no improvement was achieved and she subsequently developed respiratory and right ventricular failure, with oxygen ventilation dependence. Eventually, she was scheduled for BLx. The operation was successful and during her 2-year follow-up, no recurrence or significant postoperative complications has been reported. CONCLUSION This case presentation and literature review confirm the effectiveness of BLx as a promising treatment for PAM-diagnosed patients, improving both life expectancy and quality of life.
Collapse
Affiliation(s)
- Parviz Mardani
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical ScienceShirazIran
- Shiraz Transplant Center, Abu‐Ali Sina HospitalShiraz University of Medical SciencesShirazIran
| | - Reyhaneh Naseri
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical ScienceShirazIran
- School of MedicineShiraz University of Medical SciencesShirazIran
| | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical ScienceShirazIran
- School of MedicineShiraz University of Medical SciencesShirazIran
| | - Hadiseh Mahram
- Student Research Committee, School of MedicineShiraz University of Medical SciencesShirazIran
| | - Masoud Shafi
- Shiraz Transplant Center, Abu‐Ali Sina HospitalShiraz University of Medical SciencesShirazIran
- Department of Cardiac surgery, Abu Ali Sina HospitalShiraz University of Medical SciencesShirazIran
| | - Tahmoores Niknam
- Shiraz Transplant Center, Abu‐Ali Sina HospitalShiraz University of Medical SciencesShirazIran
| | | | | | - Armin Amirian
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical ScienceShirazIran
| |
Collapse
|
2
|
Cueto-Robledo G, Cantero-Ceballos MDC, Gonzalez-Hermosillo LM, Navarro-Vergara DI, Garcia-Cesar M, Torres-Rojas MB, Hernandez-Villa L, Serrato BG, Alfaro-Cruz A. Severe pulmonary hypertension in pulmonary alveolar microlithiasis: A comprehensive literature review. Curr Probl Cardiol 2024; 49:102453. [PMID: 38342349 DOI: 10.1016/j.cpcardiol.2024.102453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/08/2024] [Indexed: 02/13/2024]
Abstract
This review focuses on Pulmonary Alveolar Microlithiasis (PAM), an autosomal recessive genetic disorder characterized by calcium crystal deposits (microliths) resulting from loss of function of the SLC34A2 gene. PAM is a rare disease with approximately 1100 reported cases globally. The historical context of its discovery and the genetic, epidemiological, and pathophysiological aspects are discussed. PAM falls under interstitial lung diseases and is associated with pulmonary hypertension (PH), primarily categorized as Group 3 PH. The clinical manifestations, diagnostic approaches, and challenging aspects of treatment are explored. A clinical case of PAM with severe pulmonary hypertension is presented, emphasizing the importance of comprehensive evaluation and the potential benefits of phosphodiesterase-5 inhibitors (PDE5i) therapy. Despite limited therapeutic options and challenging diagnosis, this review sheds light on recent developments and emerging treatments for PAM and associated pulmonary hypertension.
Collapse
Affiliation(s)
- Guillermo Cueto-Robledo
- Cardiorespiratory Emergencies, Hospital General de México "Dr Eduardo Liceaga", Mexico City 06720, Mexico; Pulmonary Circulation Clinic, Hospital General de México "Dr. Eduardo Liceaga", Mexico City 06720, Mexico; Faculty of Medicine, National Autonomous University of Mexico, Mexico City 04510, Mexico.
| | | | | | - Dulce-Iliana Navarro-Vergara
- Cardiorespiratory Emergencies, Hospital General de México "Dr Eduardo Liceaga", Mexico City 06720, Mexico; Pulmonary Circulation Clinic, Hospital General de México "Dr. Eduardo Liceaga", Mexico City 06720, Mexico
| | - Marisol Garcia-Cesar
- Cardiorespiratory Emergencies, Hospital General de México "Dr Eduardo Liceaga", Mexico City 06720, Mexico; Pulmonary Circulation Clinic, Hospital General de México "Dr. Eduardo Liceaga", Mexico City 06720, Mexico
| | - Maria-Berenice Torres-Rojas
- Cardiorespiratory Emergencies, Hospital General de México "Dr Eduardo Liceaga", Mexico City 06720, Mexico; Pulmonary Circulation Clinic, Hospital General de México "Dr. Eduardo Liceaga", Mexico City 06720, Mexico
| | - Lizbeth Hernandez-Villa
- Cardiorespiratory Emergencies, Hospital General de México "Dr Eduardo Liceaga", Mexico City 06720, Mexico; Pulmonary Circulation Clinic, Hospital General de México "Dr. Eduardo Liceaga", Mexico City 06720, Mexico
| | - Brenda-Guadalupe Serrato
- Pneumology Department, Hospital General de Mexico "Dr. Eduardo Liceaga", Mexico City 06720, Mexico
| | - Ana Alfaro-Cruz
- Pathological Anatomy Department, Hospital General de Mexico "Dr. Eduardo Liceaga", Mexico City 06720, Mexico
| |
Collapse
|
3
|
Raavi L, Garg P, Alomari M, Celik NB, Makey IA, Thomas M, Nassar A, Sareyyupoglu B, Jacob S, Pham SM, El-Sayed Ahmed MM. Outcome of lung transplantation in patients with pulmonary alveolar microlithiasis in the era of COVID-19 infection. J Surg Case Rep 2024; 2024:rjae211. [PMID: 38605700 PMCID: PMC11008913 DOI: 10.1093/jscr/rjae211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/15/2024] [Indexed: 04/13/2024] Open
Abstract
Lung transplant recipients are at higher risk of developing COVID-19 infection compared to other solid organ transplants. The risk further increases in the unvaccinated patients. We present a case of a 43-year-old male who underwent bilateral sequential lung transplantation for pulmonary alveolar microlithiasis (PAM) and had an uneventful recovery. However, two years post-transplantation, the patient developed chronic lung allograft dysfunction (CLAD) with bronchiolitis obliterans syndrome and two episodes of COVID-19 infection. During the second episode of COVID-19 infection, the patient developed sepsis and multi-organ dysfunction ultimately resulting in death. Our case report highlights the increased susceptibility of PAM patients' post-lung transplant to COVID-19 infection. Continuous follow-up of PAM patients' post-lung transplantation is necessary to prevent unfavorable outcomes.
Collapse
Affiliation(s)
- Lekhya Raavi
- Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville 32224, FL, United States
| | - Pankaj Garg
- Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville 32224, FL, United States
| | - Mohammad Alomari
- Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville 32224, FL, United States
| | - Nafiye B Celik
- Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville 32224, FL, United States
| | - Ian A Makey
- Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville 32224, FL, United States
| | - Mathew Thomas
- Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville 32224, FL, United States
| | - Aziza Nassar
- Department of Pathology, Mayo Clinic, 12220 Kinneil Court, Jacksonville, FL 32224, United States
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville 32224, FL, United States
| | - Samuel Jacob
- Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville 32224, FL, United States
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville 32224, FL, United States
| | - Magdy M El-Sayed Ahmed
- Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville 32224, FL, United States
- Department of Surgery, Zagazig University Faculty of Medicine, Koliat Altob st., Zagazig 44519, Egypt
| |
Collapse
|
4
|
Sigur E, Roditis L, Labouret G, Bieth E, Simon S, Martin-Blondel A, Michelet M, Mittaine M, Blanchon S. Pulmonary Alveolar Microlithiasis in Children Less than 5 Years of Age. J Pediatr 2020; 217:158-164.e1. [PMID: 31761429 DOI: 10.1016/j.jpeds.2019.10.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/08/2019] [Accepted: 10/07/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To collect all published cases up to January 2019 of pulmonary alveolar microlithiasis (PAM) in patients age 5 years and under and to compare their characteristics with those of the 1022 cases in the most recent all-age cohort published in 2015. STUDY DESIGN We identified 28 cases of PAM worldwide in children age 5 years and under, accounting for only 2%-3% of all cases. RESULTS Children seem more frequently symptomatic, notably with more cough and severe acute respiratory failure, but had no reported extrapulmonary manifestation. Children with PAM evidenced less typical radiologic findings, with frequent ground glass opacities not reported in adult cases and milder calcifications as less frequent, smaller, and mainly restricted to the lower lobes. CONCLUSIONS PAM remains an uncommon diagnosis in young children, as symptoms and radiologic findings are less specific. Physicians should be aware to look for calcifications in chest computed tomography at mediastinal window and avoid elution of the bronchoalveolar lavage to find microliths. Collecting longitudinal data through an international registry would help in characterizing PAM to predict disease progression and plan lung transplantation.
Collapse
Affiliation(s)
- Elodie Sigur
- Children Hospital, Pediatric Pulmonology and Allergology Unit CHU Toulouse, Toulouse, France.
| | - Lea Roditis
- Children Hospital, Pediatric Pulmonology and Allergology Unit CHU Toulouse, Toulouse, France
| | - Geraldine Labouret
- Children Hospital, Pediatric Pulmonology and Allergology Unit CHU Toulouse, Toulouse, France
| | - Eric Bieth
- Genetic Unit CHU Toulouse, Toulouse, France
| | - Sophie Simon
- Children Hospital, Pediatric Radiology Unit CHU Toulouse, Toulouse, France
| | - Audrey Martin-Blondel
- Children Hospital, Pediatric Pulmonology and Allergology Unit CHU Toulouse, Toulouse, France
| | - Marine Michelet
- Children Hospital, Pediatric Pulmonology and Allergology Unit CHU Toulouse, Toulouse, France
| | - Marie Mittaine
- Children Hospital, Pediatric Pulmonology and Allergology Unit CHU Toulouse, Toulouse, France
| | - Sylvain Blanchon
- Children Hospital, Pediatric Pulmonology and Allergology Unit CHU Toulouse, Toulouse, France; Woman-Mother-Child, Service of Pediatrics, Pediatric Pulmonology Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
5
|
Agarwal M, Bhalla GS, Sahai K. Pulmonary alveolar microlithiasis: Incidental finding - should we Ignore? AUTOPSY AND CASE REPORTS 2019; 10:e2019133. [PMID: 32039063 PMCID: PMC6945305 DOI: 10.4322/acr.2019.133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/15/2019] [Indexed: 12/29/2022] Open
Abstract
Pulmonary alveolar microlithiasis (PAM) is a rare entity, presenting mostly as an incidental finding. This disease has an autosomal recessive inheritance with inactivating mutations in the gene “solute carrier family 34 member 2”. The present study was conducted to bring attention to this rare though preventable disease. The study was a cross-sectional descriptive study, conducted at the Department of Pathology, of a tertiary care hospital in New Dehli-India. PAMs were incidentally seen in two patients diagnosed with micronodular hepatic cirrhosis leading to reanalysis of 212 autopsies, retrospectively. Statistical analysis was done using Stata 14.0. We observed three forms (Type A, B and C) of round hyaline bodies measuring in diameter with thin delicate, radiating fibrils. These bodies were PAS positive, showed black discolouration of the pigment with von Kossa stain and birefringence on polarized microscopy using Congo red stain, however the refringence was light green as compared to apple green birefringence seen with amyloid deposition. PAM has a slow progressive course leading to a high rate of incidental detection. Drugs known to inhibit the micro-crystal growth of hydroxyapatite may slow the disease progression. The family members of patients with PAM may also be kept on follow up with regular imaging. Key messages: It is important to bring out the incidental finding as, seemingly innocuous observations may provide valuable insight into incurable diseases, especially rare diseases.
Collapse
Affiliation(s)
- Manisha Agarwal
- Army hospital (R&R), Department of Laboratory Sciences. New Delhi. India
| | | | - Kavita Sahai
- Army hospital (R&R), Department of Laboratory Sciences. New Delhi. India
| |
Collapse
|
6
|
Delic JA, Fuhrman CR, Trejo Bittar HE. Pulmonary Alveolar Microlithiasis: AIRP Best Cases in Radiologic-Pathologic Correlation. Radiographics 2017; 36:1334-8. [PMID: 27618319 DOI: 10.1148/rg.2016150259] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Editor's Note.-RadioGraphics continues to publish radiologic-pathologic case material selected from the American Institute for Radiologic Pathology (AIRP) "best case" presentations. The AIRP conducts a 4-week Radiologic Pathology Correlation Course, which is offered five times per year. On the penultimate day of the course, the best case presentation is held at the American Film Institute Silver Theater and Cultural Center in Silver Spring, Md. The AIRP faculty identifies the best cases, from each organ system, brought by the resident attendees. One or more of the best cases from each of the five courses are then solicited for publication in RadioGraphics. These cases emphasize the importance of radiologic-pathologic correlation in the imaging evaluation and diagnosis of diseases encountered at the institute and its predecessor, the Armed Forces Institute of Pathology (AFIP).
Collapse
Affiliation(s)
- Joseph A Delic
- From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Suite 174 E, Pittsburgh, PA 15213
| | - Carl R Fuhrman
- From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Suite 174 E, Pittsburgh, PA 15213
| | - Humberto E Trejo Bittar
- From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Suite 174 E, Pittsburgh, PA 15213
| |
Collapse
|
7
|
Arpağ H, Sayan M, Atilla N, Bozkuş F, Bahar AY, Kahraman H, Tokur M. A Case of Pulmonary Alveolar Microlithiasis Diagnosed by Transbronchial Biopsy. Turk Thorac J 2017; 18:134-136. [PMID: 29404178 DOI: 10.5152/turkthoracj.2017.17015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 04/20/2017] [Indexed: 11/22/2022]
Abstract
Pulmonary alveolar microlithiasis is a rare infiltrative pulmonary disease, in which intraalveolar accumulation of small stones (microliths) consisting of calcium phosphatite occurs. It is an autosomal recessive disorder. The disease occurs as a result of the disruption of type IIb sodium phosphate cotransporter in type II alveolar cells after the mutation of SLC34A2. Majority of patients are diagnosed between age 20 and 40. Here, we present a case of alveolar microlithiasis that was diagnosed with transbronchial biopsy.
Collapse
Affiliation(s)
- Hüseyin Arpağ
- Department of Chest Diseases, Kahramanmaraş Sütçü İmam University, School of Medicine, Kahramanmaraş,Turkey
| | - Muhammet Sayan
- Department of Thoracic Sugery, Kahramanmaraş Sütçü İmam University School of Medicine, Kahramanmaraş, Turkey
| | - Nurhan Atilla
- Department of Chest Diseases, Kahramanmaraş Sütçü İmam University, School of Medicine, Kahramanmaraş,Turkey
| | - Fulsen Bozkuş
- Department of Chest Diseases, Kahramanmaraş Sütçü İmam University, School of Medicine, Kahramanmaraş,Turkey
| | - Abdulkadir Yasir Bahar
- Department of Pathology, Kahramanmaraş Sütçü İmam University School of Medicine, Kahramanmaraş, Turkey
| | - Hasan Kahraman
- Department of Chest Diseases, Kahramanmaraş Sütçü İmam University, School of Medicine, Kahramanmaraş,Turkey
| | - Mahmut Tokur
- Department of Thoracic Sugery, Kahramanmaraş Sütçü İmam University School of Medicine, Kahramanmaraş, Turkey
| |
Collapse
|
8
|
Gupta PK, Mittal R, Chhabra SK. Calcified pulmonary consolidations in pulmonary alveolar microlithiasis: Uncommon computed tomographic appearance of a rare disease. Lung India 2017; 34:297-299. [PMID: 28474663 PMCID: PMC5427765 DOI: 10.4103/0970-2113.205336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Pawan K Gupta
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Richa Mittal
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Sunil K Chhabra
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| |
Collapse
|
9
|
Saito A, Nikolaidis NM, Amlal H, Uehara Y, Gardner JC, LaSance K, Pitstick LB, Bridges JP, Wikenheiser-Brokamp KA, McGraw DW, Woods JC, Sabbagh Y, Schiavi SC, Altinişik G, Jakopović M, Inoue Y, McCormack FX. Modeling pulmonary alveolar microlithiasis by epithelial deletion of the Npt2b sodium phosphate cotransporter reveals putative biomarkers and strategies for treatment. Sci Transl Med 2016; 7:313ra181. [PMID: 26560359 DOI: 10.1126/scitranslmed.aac8577] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Pulmonary alveolar microlithiasis (PAM) is a rare, autosomal recessive lung disorder associated with progressive accumulation of calcium phosphate microliths. Inactivating mutations in SLC34A2, which encodes the NPT2b sodium-dependent phosphate cotransporter, has been proposed as a cause of PAM. We show that epithelial deletion of Npt2b in mice results in a progressive pulmonary process characterized by diffuse alveolar microlith accumulation, radiographic opacification, restrictive physiology, inflammation, fibrosis, and an unexpected alveolar phospholipidosis. Cytokine and surfactant protein elevations in the alveolar lavage and serum of PAM mice and confirmed in serum from PAM patients identify serum MCP-1 (monocyte chemotactic protein 1) and SP-D (surfactant protein D) as potential biomarkers. Microliths introduced by adoptive transfer into the lungs of wild-type mice produce marked macrophage-rich inflammation and elevation of serum MCP-1 that peaks at 1 week and resolves at 1 month, concomitant with clearance of stones. Microliths isolated by bronchoalveolar lavage readily dissolve in EDTA, and therapeutic whole-lung EDTA lavage reduces the burden of stones in the lungs. A low-phosphate diet prevents microlith formation in young animals and reduces lung injury on the basis of reduction in serum SP-D. The burden of pulmonary calcium deposits in established PAM is also diminished within 4 weeks by a low-phosphate diet challenge. These data support a causative role for Npt2b in the pathogenesis of PAM and the use of the PAM mouse model as a preclinical platform for the development of biomarkers and therapeutic strategies.
Collapse
Affiliation(s)
- Atsushi Saito
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, The University of Cincinnati, Cincinnati, OH 45267, USA
| | - Nikolaos M Nikolaidis
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, The University of Cincinnati, Cincinnati, OH 45267, USA
| | - Hassane Amlal
- Department of Internal Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Yasuaki Uehara
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, The University of Cincinnati, Cincinnati, OH 45267, USA
| | - Jason C Gardner
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, The University of Cincinnati, Cincinnati, OH 45267, USA
| | - Kathleen LaSance
- Vontz Core Imaging Laboratory, Vontz Center for Molecular Studies, The University of Cincinnati, Cincinnati, OH 45267, USA
| | - Lori B Pitstick
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, The University of Cincinnati, Cincinnati, OH 45267, USA
| | - James P Bridges
- Perinatal Institute, Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | | | - Dennis W McGraw
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, The University of Cincinnati, Cincinnati, OH 45267, USA
| | - Jason C Woods
- Pulmonary Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Yves Sabbagh
- The Sanofi-Genzyme R&D Center, Genzyme, a Sanofi company, Framingham, MA 01701, USA
| | - Susan C Schiavi
- The Sanofi-Genzyme R&D Center, Genzyme, a Sanofi company, Framingham, MA 01701, USA
| | - Göksel Altinişik
- Department of Chest Diseases, Faculty of Medicine, Pamukkale University, Denizli 20160, Turkey
| | - Marko Jakopović
- Department for Respiratory Diseases, University Hospital Centre Zagreb, University of Zagreb School of Medicine, 10000 Zagreb, Croatia
| | - Yoshikazu Inoue
- Department of Diffuse Lung Diseases and Respiratory Failure, Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka 5918555, Japan
| | - Francis X McCormack
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, The University of Cincinnati, Cincinnati, OH 45267, USA.
| |
Collapse
|
10
|
Castellana G, Castellana G, Gentile M, Castellana R, Resta O. Pulmonary alveolar microlithiasis: review of the 1022 cases reported worldwide. Eur Respir Rev 2016; 24:607-20. [PMID: 26621975 PMCID: PMC9487614 DOI: 10.1183/16000617.0036-2015] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Pulmonary alveolar microlithiasis (PAM) is a rare disease characterised by the widespread intra-alveolar accumulation of minute calculi called microliths. It is caused by mutation of the SLC34A2 gene encoding the type IIb sodium phosphate cotransporter in alveolar type II cells. The present study explores the epidemiological, familial, genetic, clinical, diagnostic, radiological and therapeutic aspects with the aim of contributing to a better understanding of this uncommon disease. We searched articles on PAM published up to December 2014 and 544 papers were found, accounting for 1022 cases. PAM is present in all continents and in many nations, in particular in Turkey, China, Japan, India, Italy and the USA. Familiality is frequent. The clinical course is not uniform and the causes of this clinical variability seem to be largely nongenetic. The optimal diagnostic procedure is the association of chest high-resolution computed tomography (HRCT) with bronchoalveolar lavage, but a chest radiograph may suffice in families in which a case has already been diagnosed. Moreover, chest radiography and HRCT allow the classification of the evolutionary phase of the disease and its severity. At present lung transplantation is the only effective therapy. However, better knowledge of the gene responsible offers hope for new therapies. Familial, genetic, clinical, radiological and therapeutic aspects of pulmonary alveolarmicrolithiasis epidemiologyhttp://ow.ly/St3Mw
Collapse
Affiliation(s)
| | - Giorgio Castellana
- Institute of Respiratory Disease, Aldo Moro University of Bari, Bari, Italy
| | - Mattia Gentile
- Medical Genetics Unit, Azienda Sanitaria Locale Bari, Bari, Italy
| | | | - Onofrio Resta
- Institute of Respiratory Disease, Aldo Moro University of Bari, Bari, Italy
| |
Collapse
|
11
|
Mahmood K, Ubaid M, Mahmood A. Pulmonary microlithiasis - A case report. Respir Med Case Rep 2016; 19:112-4. [PMID: 27660745 PMCID: PMC5021849 DOI: 10.1016/j.rmcr.2016.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 08/12/2016] [Accepted: 08/15/2016] [Indexed: 12/27/2022] Open
Abstract
Pulmonary alveolar microlithiasis is a rare diffuse lung disease characterized by widespread sand-like intra-alveolar calcifications (calcospherites composed of calcium and phosphorus). Around 800 cases have been reported in the literature to date. We report here a case of a 35 years old female with prolonged h/o of exertional dyspnoea and mild cough. Clinical examination was mostly normal. Her Chest X-Ray revealed bilateral multiple nodular opacities (sand storm appearance). CT Scan chest showed diffuse micronodular calcifications with septal thickening, compatible with alveolar microlithiasis. Pulmonary function tests showed moderately restrictive lung disease. Bronchoscopic alveolar lavage revealed calcospherites in the alveloli and bronchi confirming the diagnosis of pulmonary alveolar microlithiasis.
Collapse
Affiliation(s)
- Khalid Mahmood
- Dean Faculty of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Ubaid
- Department of Medicine Unit I, Dow University of Health Sciences, Karachi, Pakistan
| | | |
Collapse
|
12
|
Emiralioglu N, Beken B, Ozcan HN, Yalcin E, Dogru D, Ozcelik U, Haliloglu M, Kiper N. Diagnosis and treatment of pulmonary alveolar microlithiasis. Pediatr Int 2016; 58:805-7. [PMID: 27553891 DOI: 10.1111/ped.13032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 04/17/2016] [Accepted: 04/25/2016] [Indexed: 11/28/2022]
Abstract
Pulmonary alveolar microlithiasis (PAM) is a rare genetic disease caused by mutations in sodium-phosphate co-transporter (SLC34A2), which encodes a type 2b sodium phosphate co-transporter. Disease is characterized by intra-alveolar microlith formation of phosphate. Turkey has a high prevalence of PAM. Herein, we report the clinical and radiological findings of three patients diagnosed with PAM and treated with disodium etidronate.
Collapse
Affiliation(s)
- Nagehan Emiralioglu
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Burcin Beken
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hatice Nursun Ozcan
- Department of Pediatric Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ebru Yalcin
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Deniz Dogru
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ugur Ozcelik
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mithat Haliloglu
- Department of Pediatric Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| |
Collapse
|
13
|
Abstract
Pulmonary alveolar microlithiasis (PAM) is a rare autosomal recessive condition that is often asymptomatic despite significant changes in chest imaging. Diagnosis is often made when patients become symptomatic in adulthood. There are still no proven treatments, but earlier diagnosis may allow for evaluation of preventative strategies that could improve outcome. It is an important diagnosis to consider in children who have marked radiographic findings with no or very mild symptoms or physical findings. Diagnosis can be made with imaging alone but may necessitate lung biopsy for definitive diagnosis.
Collapse
|
14
|
Klikovits T, Slama A, Hoetzenecker K, Waseda R, Lambers C, Murakoezy G, Jaksch P, Aigner C, Taghavi S, Klepetko W, Lang G, Hoda MA. A rare indication for lung transplantation - pulmonary alveolar microlithiasis: institutional experience of five consecutive cases. Clin Transplant 2016; 30:429-34. [PMID: 26841075 DOI: 10.1111/ctr.12705] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pulmonary alveolar microlithiasis (PAM) is a rare lung disease caused by calcifications within the alveolar space. The only known effective treatment for an end-stage PAM is lung transplantation (LuTX). METHODS We performed a retrospective chart review of all individuals that underwent lung transplantation at our center between 1989 and 2013. Five consecutive patients with PAM were identified. RESULTS Four females and one male with a mean age of 46.3 yr were identified. Extracorporeal membrane oxygenation (ECMO) support was required intraoperatively in four cases and post-operatively in one case. Mean post-operative intubation time was 3.3 (range, 2-5) d and mean intensive care unit (ICU) stay was 8.3 (range, 4-12) d. No intraoperative complications were observed. One early patient (operated in 1995) underwent acute re-transplantation on the second post-operative day (POD) and died from sepsis on the 11 POD. In one patient reperfusion edema was observed requiring a prolonged weaning process. No other severe perioperative complications were observed. Four of five patients are currently still alive with normal follow-up parameters. No recurrence of PAM was observed. CONCLUSIONS Lung transplantation is a feasible therapy option in patients with end-stage PAM showing good post-operative results comparable to other indications for LuTX.
Collapse
Affiliation(s)
- Thomas Klikovits
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Alexis Slama
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Konrad Hoetzenecker
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Ryuichi Waseda
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Christopher Lambers
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Gabriella Murakoezy
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Peter Jaksch
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Clemens Aigner
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Shahrokh Taghavi
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Walter Klepetko
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Gyoergy Lang
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Department of Thoracic Surgery, Semmelweis University Budapest, Budapest, Hungary
| | - Mir Alireza Hoda
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
15
|
Khaladkar SM, Kondapavuluri SK, Kamal A, Kalra R, Kuber R. Pulmonary Alveolar Microlithiasis - Clinico-Radiological dissociation - A case report with Radiological review. J Radiol Case Rep 2016; 10:14-21. [PMID: 27200151 DOI: 10.3941/jrcr.v10i1.2528] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Pulmonary alveolar microlithiasis (PAM) is a rare chronic lung disease characterized by deposition of intra alveolar calcium and phosphate in bilateral lung parenchyma with predominance in lower and mid zones. Etiology and pathogenesis is not fully understood. However, mutation in SLC34A2 gene that encodes a sodium phosphate co-transporter in alveolar type-II cells resulting in formation and accumulation of microliths rich in calcium phosphate due to impaired clearance is considered the cause of disease. Patients with PAM are asymptomatic till development of hypoxemia and cor pulmonale. It remains static, while in some it progresses to pulmonary fibrosis, respiratory failure and cor pulmonale. We report a case of 44 year old male patient presenting with progressive shortness of breath on exertion for one year in duration with dry cough, more since last six months. Chest radiograph showed dense micronodular opacities giving classical sandstorm appearance. High resolution computed tomography (HRCT) showed microcalcification, subpleural cystic changes and calcified pleura. Lung biopsy showed calcospherites within alveolar spaces.
Collapse
Affiliation(s)
| | | | - Anubhav Kamal
- Department of Radiodiagnosis, Dr. D. Y. Patil Medical College and Research center, Pimpri, Pune, India
| | - Raghav Kalra
- Department of Radiodiagnosis, Dr. D. Y. Patil Medical College and Research center, Pimpri, Pune, India
| | - Rajesh Kuber
- Department of Radiodiagnosis, Dr. D. Y. Patil Medical College and Research center, Pimpri, Pune, India
| |
Collapse
|
16
|
Ma T, Ren J, Yin J, Ma Z. A pedigree with pulmonary alveolar microlithiasis: a clinical case report and literature review. Cell Biochem Biophys 2015; 70:565-72. [PMID: 24817643 DOI: 10.1007/s12013-014-9957-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pulmonary alveolar microlithiasis (PAM) is a rare autosomal recessive disease characterized by the presence of innumerable calcium phosphate microliths in the alveoli. Clinical-radiological dissociation is an important hallmark of this disease. Most PAM patients are asymptomatic and pulmonary tissue changes are discovered incidentally. PAM is pathologically attributable to the formation and aggregation of calcium phosphate microliths in the alveoli after mutations in the SLC34A2 gene (the type IIb sodium-phosphate cotransporter gene) coding NaPi-IIb. In the clinical work, we discovered an inbred pedigree with PAM, which include four PAM siblings. We performed a sequence analysis of the SLC34A2 gene in all members of this PAM pedigree and found that a homozygous mutation c.575C > A (p.T192 K) in exon 6 was involved. To the best of our knowledge, this study was the first to discover nucleotide mutations in exon 6 in Asians.
Collapse
Affiliation(s)
- Tiangang Ma
- Department of Respiratory Medicine, Second Hospital of Jilin University, Changchun, 130041, Jilin Province, China
| | | | | | | |
Collapse
|
17
|
Affiliation(s)
- Marcel Koenigkam Santos
- Attending Physician at Hospital das Clínicas - Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (HCFMRP-USP), MD, Radiologist at MED - Medicina Diagnóstica, Ribeirão Preto, SP, Brazil. E-mail:
| |
Collapse
|
18
|
Vismara MFM, Colao E, Fabiani F, Bombardiere F, Tamburrini O, Alessio C, Manti F, Pelaia G, Romeo P, Iuliano R, Perrotti N. The sodium-phosphate co-transporter SLC34A2, and pulmonary alveolar microlithiasis: Presentation of an inbred family and a novel truncating mutation in exon 3. Respir Med Case Rep 2015; 16:77-80. [PMID: 26744662 PMCID: PMC4681981 DOI: 10.1016/j.rmcr.2015.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 08/06/2015] [Accepted: 08/07/2015] [Indexed: 12/12/2022] Open
Abstract
Pulmonary alveolar microlithiasis is a disorder in which many tiny fragments (microliths) of calcium phosphate gradually accumulate in alveoli. Loss of function mutations in the gene SLC34A2 coding for the sodium phosphate co-transporter (NaPi-IIb) are responsible for genetic forms of alveolar microlithiasis. We now report a consanguineous Italian family from Calabria with two affected members segregating alveolar microlithiasis in a recessive fashion. We describe, for the first time, a novel loss of function mutation in the gene coding for NaPi-IIb. A careful description of the clinical phenotype is provided together with technical details for direct sequencing of the gene.
Collapse
Affiliation(s)
- Marco Favio Michele Vismara
- Medical Genetics Residency Program TorVergata University of Rome, Italy; Medical Genetics Unit, Mater Domini University Hospital, Catanzaro, Italy; Molecular Medicine Department, Sapienza University of Rome, Italy
| | - Emma Colao
- Medical Genetics Unit, Mater Domini University Hospital, Catanzaro, Italy
| | - Fernanda Fabiani
- Medical Genetics Unit, Mater Domini University Hospital, Catanzaro, Italy
| | - Francesco Bombardiere
- Medical Genetics Residency Program TorVergata University of Rome, Italy; Medical Genetics Unit, Mater Domini University Hospital, Catanzaro, Italy
| | - Oscar Tamburrini
- Radiology Unit, Clinical and Experimental Medicine Department, Magna Graecia University of Catanzaro, Italy
| | - Caterina Alessio
- Radiology Unit, Clinical and Experimental Medicine Department, Magna Graecia University of Catanzaro, Italy
| | - Francesco Manti
- Radiology Unit, Clinical and Experimental Medicine Department, Magna Graecia University of Catanzaro, Italy
| | - Gerolamo Pelaia
- Pneumology Unit, Medical and Surgical Sciences Department, Magna Graecia University of Catanzaro, Italy
| | - Pasquale Romeo
- Pneumology Unit, Medical and Surgical Sciences Department, Magna Graecia University of Catanzaro, Italy
| | - Rodolfo Iuliano
- Medical Genetics Unit, Clinical and Experimental Medicine Department, Magna Graecia University of Catanzaro, Italy
| | - Nicola Perrotti
- Medical Genetics Unit, Health Sciences Department, Magna Graecia University of Catanzaro, Italy
| |
Collapse
|
19
|
Francisco FAF, Rodrigues RS, Barreto MM, Escuissato DL, Araujo Neto CA, Silva JLPE, Silva CS, Hochhegger B, Souza Jr. AS, Zanetti G, Marchiori E. Can chest high-resolution computed tomography findings diagnose pulmonary alveolar microlithiasis? Radiol Bras 2015; 48:205-10. [PMID: 26379317 PMCID: PMC4567357 DOI: 10.1590/0100-3984.2014.0123] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/13/2015] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The present study was aimed at retrospectively reviewing high-resolution computed tomography (HRCT) findings in patients with pulmonary alveolar microlithiasis in order to evaluate the frequency of tomographic findings and their distribution in the lung parenchyma. MATERIALS AND METHODS Thirteen patients (9 females and 4 males; age, 9 to 59 years; mean age, 34.5 years) were included in the present study. The HRCT images were independently evaluated by two observers whose decisions were made by consensus. The inclusion criterion was the presence of abnormalities typical of pulmonary alveolar microlithiasis at HRCT, which precludes lung biopsy. However, in 6 cases lung biopsy was performed. RESULTS Ground-glass opacities and small parenchymal nodules were the predominant tomographic findings, present in 100% of cases, followed by small subpleural nodules (92.3%), subpleural cysts (84.6%), subpleural linear calcifications (69.2%), crazy-paving pattern (69.2%), fissure nodularity (53.8%), calcification along interlobular septa (46.2%) and dense consolidation (46.2%). CONCLUSION As regards distribution of the lesions, there was preferential involvement of the lower third of the lungs. No predominance of distribution in axial and anteroposterior directions was observed.
Collapse
Affiliation(s)
| | - Rosana Souza Rodrigues
- PhD, Professor, Program of Post-graduation in Radiology,
Universidade Federal do Rio de Janeiro (UFRJ), Physician at the Service of Radiology,
Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro
(UFRJ) and Instituto D’Or de Pesquisa e Educação, Rio de Janeiro, RJ, Brazil
| | - Miriam Menna Barreto
- PhD, Professor, Program of Post-graduation in Radiology,
Universidade Federal do Rio de Janeiro (UFRJ), Physician at the Service of Radiology,
Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro
(UFRJ), Rio de Janeiro, RJ, Brazil
| | - Dante Luiz Escuissato
- PhD, Associate Professor of Radiology, Department of
Medical Practice, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
| | - Cesar Augusto Araujo Neto
- PhDs, Associate Professors, Department of Medicine and
Diagnostic Support, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
| | - Jorge Luiz Pereira e Silva
- PhDs, Associate Professors, Department of Medicine and
Diagnostic Support, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
| | - Claudio S. Silva
- MD, Radiology Department, Facultad de Medicina Clinica
Alemana, Universidad del Desarrollo Santiago, Chile
| | - Bruno Hochhegger
- PhD, Associate Professor of Imaging Diagnosis, Universidade
Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Arthur Soares Souza Jr.
- PhD, Professor, Faculdade de Medicina de São José do Rio
Preto (Famerp), São José do Rio Preto, SP, Brazil
| | - Gláucia Zanetti
- PhD, Professor, Program of Post-graduation in Radiology at
Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Professor of Medical
Practice, Faculdade de Medicina de Petrópolis, Petrópolis, RJ, Brazil
| | - Edson Marchiori
- PhD, Full Professor Emeritus, Universidade Federal
Fluminense (UFF), Niterói, RJ, Associate Professor, Universidade Federal do Rio de
Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| |
Collapse
|
20
|
Ganesan N, Ambroise MM, Ramdas A, Kisku KH, Singh K, Varghese RGB. Pulmonary alveolar microlithiasis: an interesting case report with systematic review of Indian literature. Front Med 2015; 9:229-38. [PMID: 26024716 DOI: 10.1007/s11684-015-0394-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 03/12/2015] [Indexed: 12/31/2022]
Abstract
Pulmonary alveolar microlithiasis is a rare disease characterized by intra-alveolar presence of microliths. This study reports an interesting case of pulmonary alveolar microlithiasis and provides a systematic review of cases reported from India. A 23-year-old female presented with a history of cough, wheeze, chest pain, and episodic wheeze for five months. Pulmonary function tests demonstrated an obstructive pattern, and chest Xray showed fine micronodular opacities predominantly involving the middle and lower zones of both lungs. Transbronchial lung biopsy revealed the diagnosis. She responded well to inhaled steroid therapy. A systematic review of literature was performed and identified 73 cases of pulmonary alveolar microlithiasis reported from India. The mean (SD) age of the patients was 28.8 (14.9) years, with an almost equal male:female ratio. Many patients were asymptomatic at presentation. Breathlessness and cough were the most common symptoms, and the disease progressed into respiratory failure associated with cor pulmonale. About one-third of the cases were initially misdiagnosed and treated as pulmonary tuberculosis. Extra-pulmonary manifestations and comorbidities were also evident in our series. This systematic review helps to determine epidemiological and clinical characteristics of pulmonary alveolar microlithiasis. Further research is needed to elucidate the etiopathogenesis, diagnosis, and therapeutic options, which are beneficial in developing and identifying cost-effective treatment for pulmonary alveolar microlithiasis.
Collapse
Affiliation(s)
- Nidhya Ganesan
- Department of Pathology, Pondicherry Institute of Medical Sciences, Pondicherry, 605014, India,
| | | | | | | | | | | |
Collapse
|
21
|
Castellana G, Carone D, Castellana M. Microlithiasis of Seminal Vesicles and Severe Oligoasthenospermia in Pulmonary Alveolar Microlithiasis (PAM): Report of An Unusual Sporadic Case. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2015; 9:137-40. [PMID: 25918602 PMCID: PMC4410032 DOI: 10.22074/ijfs.2015.4218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 12/30/2013] [Indexed: 12/19/2022]
Abstract
Pulmonary alveolar microlithiasis (PAM) is classified as an elective dysmetabolic thesaurotic pneumoalveolitis and characterized by the presence within the alveoli of the lungs of myriad of tiny calculi. The classic presentation of the chest radiography is unmistakable with multiple small "sand-like" opacities diffusely involving both lung fields. We present a case of male infertility for hypoposia and severe oligoasthenospermia in a young patient with recurrent haematuria and small calcifications in the seminal vesicles similar to pulmonary microliths. PAM was diagnosed on routine chest radiography, com- puter tomography (CT), transbronchial biopsy and bronchoalveolar lavage (BAL).
Collapse
Affiliation(s)
- Giuseppe Castellana
- District Health Center, ASL BA, via de Amicis, Conversano (70014), Bari, Italy
| | - Domenico Carone
- Center of Human Reproduction and Andrology (CREA), Via Scoglio del Tonno 79/81, Taranto (74120), Italy
| | - Marco Castellana
- University of Bari, Piazza Giulio Cesare 11, Bari (70124), Italy
| |
Collapse
|
22
|
Cakir E, Gedik AH, Özdemir A, Buyukpınarbasili N, Bilgin M, Ozgen IT. Response to Disodium Etidronate Treatment in Three Siblings with Pulmonary Alveolar Microlithiasis. Respiration 2015; 89:583-6. [DOI: 10.1159/000375464] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 01/22/2015] [Indexed: 11/19/2022] Open
|
23
|
Rittayamai N, Muangman N, Ruangchira-Urai R. Extensive pulmonary alveolar microlithiasis. Respirol Case Rep 2014; 2:4-6. [PMID: 25473548 PMCID: PMC4184717 DOI: 10.1002/rcr2.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 10/11/2013] [Indexed: 12/03/2022] Open
Abstract
Pulmonary alveolar microlithiasis is a rare pulmonary disorder that is caused by abnormal sodium-dependent phosphate co-transporter from the mutation of SLC34A2 gene, leading to accumulation of microliths in the alveoli. We report the extensive pulmonary alveolar microlithiasis in an elderly woman who presented with progressive dyspnea for 2 months. Chest radiograph revealed diffuse pulmonary calcification. Tissue histopathology from open lung biopsy demonstrated widespread intra-alveolar laminated calcium deposits compatible with pulmonary alveolar microlithiasis.
Collapse
Affiliation(s)
- Nuttapol Rittayamai
- Division of Respiratory Diseases and Tuberbulosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University Bangkok, Thailand
| | - Nisa Muangman
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University Bangkok, Thailand
| | - Ruchira Ruangchira-Urai
- Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University Bangkok, Thailand
| |
Collapse
|
24
|
Sigari N, Nikkhoo B. First presentation of a case of pulmonary alveolar microlithiasis with spontaneous pneumothorax. Oman Med J 2014; 29:450-3. [PMID: 25584164 PMCID: PMC4289487 DOI: 10.5001/omj.2014.117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 04/24/2013] [Indexed: 01/06/2023] Open
Abstract
Pulmonary Alveolar Microlithiasis (PAM) is a rare disease of unknown origin. It is characterized by the presence of small calculi within the alveolar spaces, and has various clinical manifestations. Some patients may be asymptomatic for a long period of time with subsequent occurrence of dyspnea, dry cough, chest pain, and eventually, respiratory failure. Recurrent spontaneous pneumothorax episodes are a late complication of the disease. We report the case of an alveolar microlithiasis episode in a 42-year-old male, admitted to Tohid Hospital, Iran, whose first clinical presentation was symptoms of pneumothorax. He was admitted with sudden onset dyspnea and right-sided pleuretic chest pain. Following treatment of pneumothorax after chest tube placement, the pulmonary function revealed normal indices, and chest radiograph demonstrated diffuse confluence of dense micronodular infiltrate. High-resolution computerized tomography scan showed diffuse ground glass attenuation and calcifications along the interlobular septa and subpleural regions. Transbronchial lung biopsy confirmed the diagnosis of PAM.
Collapse
Affiliation(s)
- Naseh Sigari
- Department of Internal Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Bahram Nikkhoo
- Department of Pathology, Kurdistan University of Medical Sciences, Sanandaj, Iran
| |
Collapse
|
25
|
Güçyetmez B, Ogan A, Cimet Ayyıldız A, Yalçın Güder B, Klepetko W. Lung transplantation in an intensive care patient with pulmonary alveolar microlithiasis - a case report. F1000Res 2014; 3:118. [PMID: 25165536 PMCID: PMC4133765 DOI: 10.12688/f1000research.4035.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2014] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Pulmonary alveolar microlithiasis (PAM) is an autosomal recessive disease characterized by the deposition of phosphate and calcium in the alveoli. The disease progresses asymptomatically until later stages. When it becomes symptomatic, lung transplantations performed before the onset of right heart failure may improve life expectancy and quality. Here we present a case report concerning the very first Turkish PAM patient to have undergone lung transplantation surgery. Patient information: A 52 year-old female, Caucasian patient, already diagnosed with PAM in infancy, was admitted to the intensive care unit, diagnosed with pneumonia and hospitalized for 20 days. We decided to refer the patient to a specialized center for lung transplantation. Bilateral lung transplantation was performed in Vienna 14 months later and no recurrence was observed during the first postoperative year. CONCLUSION Bilateral lung transplantation may improve both the life expectancy and the quality of life of PAM diagnosed patients with severe respiratory failure who do not suffer from right heart failure. The risk of recurrence should not be considered as a justifying reason to avoid transplantation as a treatment method.
Collapse
Affiliation(s)
- Bülent Güçyetmez
- Intensive Care Unit, International Hospital, Istanbul, 34149, Turkey
| | - Aylin Ogan
- Intensive Care Unit, International Hospital, Istanbul, 34149, Turkey
| | | | | | - Walter Klepetko
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, A-1090, Austria
| |
Collapse
|
26
|
Lim CT, Phoa LL. A silent storm. Respirol Case Rep 2013; 2:18-20. [PMID: 25473553 PMCID: PMC4184723 DOI: 10.1002/rcr2.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 10/21/2013] [Accepted: 10/30/2013] [Indexed: 11/08/2022] Open
Abstract
Pulmonary alveolar microlithiasis is a rare, inherited pulmonary disorder affecting young adults. Diagnosis and monitoring is important as it may progress to pulmonary fibrosis and respiratory failure. No effective treatment has been found to date.
Collapse
Affiliation(s)
- Chiow Teen Lim
- Department of Respiratory and Critical Care Medicine, Khoo Teck Puat Hospital Singapore, Singapore
| | - Lee Lan Phoa
- Department of Respiratory and Critical Care Medicine, Khoo Teck Puat Hospital Singapore, Singapore
| |
Collapse
|
27
|
Pulmonary alveolar microlithiasis: imaging characteristics of planar and SPECT/CT bone scan versus 18F-FDG and 18F-sodium fluoride PET/CT scanning. Jpn J Radiol 2013; 31:766-9. [DOI: 10.1007/s11604-013-0250-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 09/17/2013] [Indexed: 10/26/2022]
|
28
|
de Brot S, Hilbe M. Pulmonary alveolar microlithiasis with concurrent pleural mesothelioma in a dog. J Vet Diagn Invest 2013; 25:798-802. [PMID: 24081932 DOI: 10.1177/1040638713504571] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pulmonary alveolar microlithiasis (PAM) is a rare pulmonary disorder characterized by the accumulation of calcium phosphate microliths within the alveoli, with only a few cases described in animals. A 10-year-old female Bulldog was euthanized due to history of dyspnea and recurrent pleural and pericardial effusions. At necropsy, numerous multifocal to coalescent protruding nodules of 1-5 mm in diameter were scattered throughout the thoracic serosal surfaces. Moreover, lungs showed a diffuse pale gray color and had a generalized fine grainy consistency. Histological investigations revealed abundant intra-alveolar laminated microliths that stained positive with periodic acid-Schiff and von Kossa stains. The pulmonary interstitium showed multifocal, mild to moderate thickening, due to collagen deposition and mild hyperplasia of type 2 pneumocytes. The pulmonary lesion was not associated with any inflammatory response, and mineral deposition was not observed in any other organ or tissue. In addition, pulmonary, pericardial, and pleural surfaces were extensively infiltrated by an epithelioid mesothelioma. Immunohistochemical staining revealed neoplastic cells that strongly coexpressed vimentin and cytokeratin, supporting the diagnosis of mesothelioma. An overview of PAM, including pathogenesis and histological characteristics, are discussed in relation to the concurrent pleural mesothelioma. The potential cause and effect relationship between the 2 conditions could neither be established nor ruled out.
Collapse
Affiliation(s)
- Simone de Brot
- 1Simone de Brot, Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 268, CH-8057 Zurich, Switzerland.
| | | |
Collapse
|
29
|
Dahabreh M, Najada A. Pulmonary alveolar microlithiasis in an 8-month-old infant. ACTA ACUST UNITED AC 2013; 29:55-9. [DOI: 10.1179/146532809x402042] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
30
|
Abstract
Pulmonary alveolar microlithiasis (PAM) is a rare, chronic lung disease with bilateral intra-alveolar calcium and phosphate deposition throughout the lung parenchyma with predominance to lower and midzone. Although, etiology and pathogenesis of PAM is not fully understood, the mutation in SLC34A2 gene that encodes a sodium-phosphate co-transporter in alveolar type II cells resulting in the accumulation and forming of microliths rich in calcium phosphate (due to impaired clearance) are considered to be the cause of the disease. Chest radiograph and high-resolution CT of thorax are nearly pathognomonic for diagnosing PAM. HRCT demonstrates diffuse micronodules showing slight perilobular predominance resulting in calcification of interlobular septa. Patients with PAM are asymptomatic till development of hypoxemia and cor-pulmonale. No therapy has been proven to be beneficial except lung transplantation.
Collapse
Affiliation(s)
- Surender Kashyap
- Department of Pulmonary Medicine, Kalpana Chawla Government Medical College, Karnal, Haryana, India
| | | |
Collapse
|
31
|
|
32
|
Abstract
Pulmonary alveolar microlithiasis (PAM) is a rare, familial disease of unknown aetiology characterised by intra-alveolar formation and accumulation of microliths. Multiple formalin-fixed tissues were submitted from a 5-month-old female alpaca that died suddenly without significant clinical signs. No gross abnormalities were observed on postmortem examination. Histological findings included PAM and severe centrilobular hepatic necrosis. Although the hepatic lesion was the likely cause of death, PAM was an incidental finding that has not been reported previously in alpacas. An overview of PAM, including pathogenesis and histopathological characteristics, are discussed in relation to the concurrent hepatic disease in the present case.
Collapse
Affiliation(s)
- E J Lee
- Department of Primary Industries, State Veterinary Diagnostic Laboratory, Elizabeth Macarthur Agricultural Institute, Woodbridge Road, Menangle, New South Wales 2568, Australia.
| | | | | | | |
Collapse
|
33
|
Günay E, Ozcan A, Günay S, Tatci E, Keyf AI, Simsek C. Pulmonary alveolar microlithiasis with low fluorodeoxyglucose accumulation in PET/computed tomography. Ann Thorac Med 2012; 6:237-40. [PMID: 21977072 PMCID: PMC3183644 DOI: 10.4103/1817-1737.84781] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 04/15/2011] [Indexed: 12/17/2022] Open
Abstract
Pulmonary alveolar microlithiasis (PAM) is an uncommon lung disease characterized by accumulation of intraalveolar calcifications. The disease can be diagnosed based on the radiological findings. We present a 27-year-old women with five-year history of shortness of breath. She was diagnosed with PAM due to the presence of the characteristic chest X-ray and thorax computed tomography (CT) findings. We performed 18F-fluorodeoxyglucose (FDG)-PET/CT imaging in order to detect any evidence of inflamation in the lung before deciding an anti-inflammatory treatment. The lung regions with dense calcifications revealed low FDG uptakes (SUVmax: 2.7) and the lung regions without calcifications showed lower FDG uptakes. No further treatment modality was planned besides inhaler salbutamol. Herein, we discuss this rare entity with literature search.
Collapse
Affiliation(s)
- Ersin Günay
- Department of Chest Diseases, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | | | | | | | | | | |
Collapse
|
34
|
Proesmans M, Boon M, Verbeken E, Ozcelik U, Kiper N, Van de Casseye W, De Boeck K. Pulmonary alveolar microlithiasis: a case report and review of the literature. Eur J Pediatr 2012; 171:1069-72. [PMID: 22311166 DOI: 10.1007/s00431-012-1678-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 01/17/2012] [Indexed: 12/25/2022]
Abstract
A 12-year-old girl of Turkish descent was referred 6 weeks after an influenza A infection because of persistent chest X-ray abnormalities compatible with interstitial lung disease. The clinically suspected diagnosis of pulmonary alveolar microlithiasis (PAM) supported by pathognomonic radiological abnormalities was confirmed by genetic analysis. The clinical presentation of PAM is illustrated by a case and review of the current literature on this subject: you only see what you know.
Collapse
Affiliation(s)
- M Proesmans
- Department of Pediatrics, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | | | | | | | | | | | | |
Collapse
|
35
|
Jönsson ÅLM, Hilberg O, Bendstrup EM, Mogensen S, Simonsen U. SLC34A2 gene mutation may explain comorbidity of pulmonary alveolar microlithiasis and aortic valve sclerosis. Am J Respir Crit Care Med 2012; 185:464. [PMID: 22336687 DOI: 10.1164/ajrccm.185.4.464] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
|
36
|
Abstract
The interstitial lung diseases (ILDs), or diffuse parenchymal lung diseases, are a heterogeneous collection of more than 100 different pulmonary disorders that affect the tissue and spaces surrounding the alveoli. Patients affected by ILD usually present with shortness of breath or cough; for many, there is evidence of pulmonary restriction, decreased diffusion capacity, and radiographic appearance of alveolar and/or reticulonodular infiltrates. This article reviews the inherited ILDs, with a focus on the diseases that may be seen by pulmonologists caring for adult patients. The authors conclude by briefly discussing the utility of genetic testing in this population.
Collapse
Affiliation(s)
- Megan Stuebner Devine
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, TX 75390-8591, USA
| | | |
Collapse
|
37
|
Kang HW, Kim TO, Oh IJ, Kim YI, Lim SC, Choi YD, Song SY, Seon HJ, Kwon YS. A case of pulmonary alveolar microlithiasis. J Korean Med Sci 2011; 26:1391-3. [PMID: 22022196 PMCID: PMC3192355 DOI: 10.3346/jkms.2011.26.10.1391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 08/02/2011] [Indexed: 11/20/2022] Open
Abstract
Pulmonary alveolar microlithiasis (PAM) is a rare disease with unknown etiology and pathogenesis. It is characterized by diffuse, innumerable, and minute calculi, called microlithiasis in the alveoli. More than half of reported cases are asymptomatic at the time of diagnosis. We describe the first case of PAM in Korea. A 19-yr-old man without respiratory symptoms presented with interstitial thickening on the chest radiograph. His chest high resolution CT scan showed diffusely scattered, ill defined tiny micronodules and interstitial thickening. Open lung biopsy confirmed the diagnosis of PAM. He was followed up for 6 months without treatment, and no progression was noticed.
Collapse
Affiliation(s)
- Hyun Wook Kang
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Tae Ok Kim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - In-Jae Oh
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Yu-Il Kim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Sung Chul Lim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Yoo-Duk Choi
- Department of Pathology, Chonnam National University Hospital, Gwangju, Korea
| | - Sang-Yun Song
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Gwangju, Korea
| | - Hyun Ju Seon
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Yong Soo Kwon
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| |
Collapse
|
38
|
Malhotra B, Sabharwal R, Singh M, Singh A. Pulmonary alveolar microlithiasis with calcified pleural plaques. Lung India 2011; 27:250-2. [PMID: 21139727 PMCID: PMC2988181 DOI: 10.4103/0970-2113.71967] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pulmonary alveolar microlithiasis (PAM) is a rare disease. Herein we report a case of pulmonary alveolar microlithiasis who was suspected to have the disease on chest X-ray and was confirmed on high resolution CT and transbronchial lung biopsy. These investigations showed characteristic features of pulmonary alveolar microlithiasis with diffuse interstitial pulmonary fibrosis.
Collapse
Affiliation(s)
- Balbir Malhotra
- Department of Chest and TB, Government Medical College Amritsar, India
| | | | | | | |
Collapse
|
39
|
Une cause rare de miliaire pulmonaire. Rev Mal Respir 2011; 28:660-3. [DOI: 10.1016/j.rmr.2010.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Accepted: 12/20/2010] [Indexed: 11/17/2022]
|
40
|
Affiliation(s)
- Jayakrishnan Krishnakurup
- Section of Geriatric Medicine, Bridgeport Hospital/Yale New Haven Health System, Bridgeport, CT, USA
| | | |
Collapse
|
41
|
Lee BH, Kang BS, Min JW, Park SJ, Kim TH, Chung JH, Park CS. A Case of Pulmonary Alveolar Microlithiasis. Tuberc Respir Dis (Seoul) 2011. [DOI: 10.4046/trd.2011.71.1.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Bu Hyun Lee
- Department of Internal Medicine, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea
| | - Byung Soo Kang
- Department of Internal Medicine, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea
| | - Joo-Won Min
- Department of Internal Medicine, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea
| | - Sang Joon Park
- Department of Internal Medicine, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea
| | - Tae Ho Kim
- Department of Internal Medicine, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea
| | - Jae Ho Chung
- Department of Internal Medicine, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea
| | - Chan Sub Park
- Department of Radiology, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea
| |
Collapse
|
42
|
Ozcelik U, Yalcin E, Ariyurek M, Ersoz DD, Cinel G, Gulhan B, Kiper N. Long-term results of disodium etidronate treatment in pulmonary alveolar microlithiasis. Pediatr Pulmonol 2010; 45:514-7. [PMID: 20425862 DOI: 10.1002/ppul.21209] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Pulmonary alveolar microlithiasis (PAM) is a rare disease with alveolar microliths mainly composed of calcium phosphate. The gene responsible for the disease is SLC34A2, which encodes a type-IIb sodium phosphate cotransporter, has been described recently. Treatment of this disease is not clearly defined. Disodium etidronate is a member of bisphonates and it has been administered in these patients due to its inhibitory effect on the precipitation of hydroxyapatite microcrystals. Here, clinical and radiological improvement of two patients with PAM who were treated with disodium etidronate for 9 and 11 years, respectively, are presented. The pathogenetic mechanism of this treatment on the genetic basis of disease is discussed.
Collapse
Affiliation(s)
- Ugur Ozcelik
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, 06100 Sihhiye, Ankara, Turkey.
| | | | | | | | | | | | | |
Collapse
|
43
|
Storey B, Faruqi S, Campbell A, Morice AH. A speckled chest radiograph. Am J Med 2010; 123:e3-4. [PMID: 20362740 DOI: 10.1016/j.amjmed.2009.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Revised: 09/04/2009] [Accepted: 09/08/2009] [Indexed: 11/25/2022]
Affiliation(s)
- Ben Storey
- Department of Respiratory Medicine, Castle Hill Hospital, Hull and East Yorkshire Hospitals NHS Trust, Cottingham, UK
| | | | | | | |
Collapse
|
44
|
Olauson H, Brandenburg V, Larsson TE. Mutation analysis and serum FGF23 level in a patient with pulmonary alveolar microlithiasis. Endocrine 2010; 37:244-8. [PMID: 20960258 DOI: 10.1007/s12020-009-9299-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Accepted: 12/21/2009] [Indexed: 11/26/2022]
Abstract
Pulmonary alveolar microlithiasis (PAM) is a rare, hereditary disorder characterized by ectopic formation of calcium-phosphate microliths in the alveolar space. PAM has been reported to arise from inactivating mutations in SLC34A2, encoding a sodium-dependent phosphate co-transporter essential for phosphate transport in the lungs and small intestine. Serum levels of the phosphaturic hormone fibroblast growth factor-23 (FGF23) in PAM have not been determined. Our objectives were to investigate the genetic etiology and circulating level of FGF23 in a 50-year-old male with clinical characteristics of PAM and extra-pulmonary calcifications. The SLC34A2 and FGF23 genes were sequenced for mutations and serum FGF23 analyzed by ELISA. We found no disease-causing mutations or single nucleotide polymorphisms in the genes investigated. Importantly, repeated measurements revealed undetectable or markedly low serum FGF23 (<3-11 RU/ml). Surprisingly, in the face of low serum FGF23, 1,25-dihydroxy vitamin D₃ level was low-normal and parathyroid hormone mildly elevated. Total 24-h urinary excretion of phosphate and calcium were low, as was fractional urinary excretion of calcium. In contrast, fractional excretion of phosphate was above normal, likely due to elevated PTH. Collectively, PAM may be a polygenic disorder that arises from mutations other than in SLC34A2. The low FGF23 level in our PAM patient supports an intestinal-bone axis, leading to decreased FGF23 expression when intestinal phosphate absorption is compromised.
Collapse
Affiliation(s)
- Hannes Olauson
- Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | | | | |
Collapse
|
45
|
Saouab R, Dafiri R. Une cause rare de dyspnée chez l’enfant. Arch Pediatr 2010; 17:281, 290-3. [DOI: 10.1016/j.arcped.2009.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2009] [Revised: 08/07/2009] [Accepted: 11/29/2009] [Indexed: 11/30/2022]
|
46
|
Samano MN, Waisberg DR, Canzian M, Campos SV, Pêgo-Fernandes PM, Jatene FB. Lung transplantation for pulmonary alveolar microlithiasis: a case report. Clinics (Sao Paulo) 2010; 65:233-6. [PMID: 20186308 PMCID: PMC2827711 DOI: 10.1590/s1807-59322010000200016] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Marcos Naoyuki Samano
- Thoracic Surgery Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil
| | | | - Mauro Canzian
- Pathology Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil
| | - Silvia Vidal Campos
- Lung Transplant Group, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil,
, Tel.: 55 11 3069.5248
| | - Paulo M. Pêgo-Fernandes
- Thoracic Surgery Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil
| | - Fabio B. Jatene
- Thoracic Surgery Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil
| |
Collapse
|
47
|
Dogan OT, Ozsahin SL, Gul E, Arslan S, Koksal B, Berk S, Ozdemir O, Akkurt I. A frame-shift mutation in the SLC34A2 gene in three patients with pulmonary alveolar microlithiasis in an inbred family. Intern Med 2010; 49:45-9. [PMID: 20046000 DOI: 10.2169/internalmedicine.49.2702] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Pulmonary alveolar microlithiasis (PAM) is a rare disease characterized by the presence of small calculi in the alveolar space. The SLC34A2 is thought to be responsible for the disease. We encountered three siblings of an inbred family who have PAM. We examined the family of the proband who was admitted with dyspnea on exertion and cough, and eventually was diagnosed with PAM. Genetic analysis revealed that both parents (a consanguineous marriage) of the proband were carriers with heterozygous mutation of SLC34A2 gene, and three of their children were diagnosed with PAM with homozygous mutation in the SLC34A2 gene. These findings suggest that impaired activity of the SLC34A2 gene may be responsible for familial PAM.
Collapse
Affiliation(s)
- Omer Tamer Dogan
- Department of Chest Diseases, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Akyildiz EU, Ursavas A, Ogur U. Pulmonary alveolar microlithiasis in a textile worker. Ann Thorac Surg 2009; 88:e22-4. [PMID: 19699880 DOI: 10.1016/j.athoracsur.2009.06.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Revised: 05/26/2009] [Accepted: 06/09/2009] [Indexed: 10/20/2022]
Abstract
Pulmonary alveolar microlithiasis is a rare lung disease characterized by small calculi, called calsispheritis, in the alveoli. The disease usually presents at age 20 to 30 years and is mostly diagnosed incidentally or detected on routine pulmonary roentgenograms. The radiologic findings are pathognomonic for the disease. Pulmonary alveolar microlithiasis most frequently appears in Turkey, followed by Italy. We present the case of a 29-year-old female textile worker found to have widespread micronodules after a routine pulmonary roentgenogram.
Collapse
Affiliation(s)
- Elif Ulker Akyildiz
- Department of Pathology, Uludag University School of Medicine, Bursa, Turkey.
| | | | | |
Collapse
|
49
|
Coulibaly B, Fernandez C, Reynaud-Gaubert M, D'Journo X, Doddoli C, Taséi AM. [Alveolar microlithiasis with severe interstitial fibrosis leading to lung transplantation]. Ann Pathol 2009; 29:241-4. [PMID: 19619834 DOI: 10.1016/j.annpat.2009.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2009] [Indexed: 12/20/2022]
Abstract
Pulmonary alveolar microlithiasis is a rare disease, characterized by extensive phosphocalcic concretions within the alveolar spaces. Pulmonary alveolar microlithiasis is usually asymptomatic and is incidentally found because radiologic findings are characteristic. In about half of the cases, it is an autosomal recessive disorder due to mutations in the SLC34A2 gene. Pulmonary alveolar microlithiasis can easily be diagnosed by bronchioloalveolar lavage or transbronchial biopsy. The clinical course is usually stable during several years and lung transplantation is the only effective treatment when a respiratory failure occurs. A 49-year-old woman was referred with a restrictive respiratory failure due to a pulmonary alveolar microlithiasis incidentally discovered on a chest radiography when she was 11 and was confirmed by surgical lung biopsy. She was asymptomatic until she was 43 when she presented a progressive dyspnea leading to continuous oxygen administration 4 years later. Laboratory findings only showed a polyglobulia related to hypoxemia. Chest radiography and computed tomography chest scan revealed a bilateral symmetric micronodular pattern. She underwent a lung transplantation when she was 49. Pathological examination confirmed the diagnosis of diffuse pulmonary alveolar microlithiasis with interstitial fibrosis. The patient died 3 months after surgery in an infectious context.
Collapse
Affiliation(s)
- Béma Coulibaly
- Service d'anatomie pathologique et de neuropathologie, CHU de La Timone, 13385 Marseille cedex 05, France.
| | | | | | | | | | | |
Collapse
|
50
|
Terada T. Pulmonary alveolar microlithiasis with cor pulmonale: an autopsy case demonstrating a marked decrease in pulmonary vascular beds. Respir Med 2009; 103:1768-71. [PMID: 19523797 DOI: 10.1016/j.rmed.2009.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2009] [Revised: 04/21/2009] [Accepted: 05/14/2009] [Indexed: 11/25/2022]
Abstract
Pulmonary alveolar microlithiasis (PAM) is a very rare autosomal recessive disorder in which microliths are formed in the alveolar space. PAM is infrequently complicated by pulmonary hypertension, the cause of which is unclear. The author in this paper found that the pulmonary hypertension was caused by a marked decrease in pulmonary vascular beds. Here, an autopsy case of PAM with a marked cor pulmonale is reported. A 14-year-old woman was found to have an abnormal pulmonary shadow, but the cause was unclear. At 24 years, she was diagnosed with a diffuse pulmonary abnormal shadow. At 42 years, she was diagnosed with PAM by imaging techniques. Her condition gradually worsened and she had to be treated with oxygen. She died of respiratory failure at 54 years. An autopsy revealed severe PAM and marked cor pulmonale. The heart weighed 360 g and right ventricular thickness was 10 mm (normal, 2-3 mm). Microscopically, the alveolar space was diffusely filled with microliths, and heart failure cells were recognized. Bone formations were scattered. The alveolar walls showed fibrous thickening, and pulmonary arteries showed atherosclerosis. The right ventricle showed marked cardiac hypertrophy. Chronic severe liver congestion was noted. A morphometric analysis using CD34-stained specimens showed a marked decrease (one tenth) in pulmonary capillary beds (capillary number: 8.6 +/- 3.1 per image), compared with normal lungs obtained from two other autopsies (85.3 +/- 9.4 and 96.2 +/- 10,3). It was concluded that the cor pulmonale and pulmonary hypertension in the present case were caused by the marked decrease of the pulmonary arterial vascular beds. More research is required regarding the etiology and treatment of PAM.
Collapse
Affiliation(s)
- Tadashi Terada
- Department of Pathology, Shizuoka City Shimizu Hospital, Miyakami 1231, Shimizu-Ku, Shizuoka 424-8636, Japan.
| |
Collapse
|