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Dobashi N, Sada KE, Kanemori G, Okada T, Tarutani Y, Yamamoto M, Yabe M, Inoue K, Imaizumi Y, Nishii M, Katsurada M, Misaki K. Pulmonary alveolar proteinosis during treatment of immune-mediated necrotizing myopathy. Int J Rheum Dis 2024; 27:e15080. [PMID: 38339847 DOI: 10.1111/1756-185x.15080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/08/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Affiliation(s)
- Naofumi Dobashi
- Department of Internal Medicine, Kochi Prefectural Hata-Kenmin Hospital, Sukumo, Japan
- Department of Clinical Epidemiology, Kochi Medical School, Kochi University, Nankoku, Japan
- Department of Rheumatology, Kita-Harima Medical Center, Hyogo, Japan
- Rheumatology Center, Kita-Harima Medical Center, Hyogo, Japan
| | - Ken-Ei Sada
- Department of Internal Medicine, Kochi Prefectural Hata-Kenmin Hospital, Sukumo, Japan
- Department of Clinical Epidemiology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Gen Kanemori
- Department of Rheumatology, Kita-Harima Medical Center, Hyogo, Japan
| | - Takuya Okada
- Department of Rheumatology, Kita-Harima Medical Center, Hyogo, Japan
- Rheumatology Center, Kita-Harima Medical Center, Hyogo, Japan
| | - Yusuke Tarutani
- Department of Rheumatology, Kita-Harima Medical Center, Hyogo, Japan
- Rheumatology Center, Kita-Harima Medical Center, Hyogo, Japan
| | - Mako Yamamoto
- Department of Rheumatology, Kita-Harima Medical Center, Hyogo, Japan
- Rheumatology Center, Kita-Harima Medical Center, Hyogo, Japan
| | - Moemi Yabe
- Department of Rheumatology, Kita-Harima Medical Center, Hyogo, Japan
- Rheumatology Center, Kita-Harima Medical Center, Hyogo, Japan
| | - Kenshi Inoue
- Department of Rheumatology, Kita-Harima Medical Center, Hyogo, Japan
- Rheumatology Center, Kita-Harima Medical Center, Hyogo, Japan
| | - Yasuhiko Imaizumi
- Department of Rheumatology, Kita-Harima Medical Center, Hyogo, Japan
- Rheumatology Center, Kita-Harima Medical Center, Hyogo, Japan
| | - Masahiko Nishii
- Department of Oncology Respiratory Medicine, Kita-Harima Medical Center, Hyogo, Japan
| | - Masahiro Katsurada
- Department of Oncology Respiratory Medicine, Kita-Harima Medical Center, Hyogo, Japan
| | - Kenta Misaki
- Department of Rheumatology, Kita-Harima Medical Center, Hyogo, Japan
- Rheumatology Center, Kita-Harima Medical Center, Hyogo, Japan
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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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Sakaue S, Yamaguchi E, Inoue Y, Takahashi M, Hirata J, Suzuki K, Ito S, Arai T, Hirose M, Tanino Y, Nikaido T, Ichiwata T, Ohkouchi S, Hirano T, Takada T, Miyawaki S, Dofuku S, Maeda Y, Nii T, Kishikawa T, Ogawa K, Masuda T, Yamamoto K, Sonehara K, Tazawa R, Morimoto K, Takaki M, Konno S, Suzuki M, Tomii K, Nakagawa A, Handa T, Tanizawa K, Ishii H, Ishida M, Kato T, Takeda N, Yokomura K, Matsui T, Watanabe M, Inoue H, Imaizumi K, Goto Y, Kida H, Fujisawa T, Suda T, Yamada T, Satake Y, Ibata H, Hizawa N, Mochizuki H, Kumanogoh A, Matsuda F, Nakata K, Hirota T, Tamari M, Okada Y. Genetic determinants of risk in autoimmune pulmonary alveolar proteinosis. Nat Commun 2021; 12:1032. [PMID: 33589587 PMCID: PMC7884840 DOI: 10.1038/s41467-021-21011-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 01/08/2021] [Indexed: 11/13/2022] Open
Abstract
Pulmonary alveolar proteinosis (PAP) is a devastating lung disease caused by abnormal surfactant homeostasis, with a prevalence of 6-7 cases per million population worldwide. While mutations causing hereditary PAP have been reported, the genetic basis contributing to autoimmune PAP (aPAP) has not been thoroughly investigated. Here, we conducted a genome-wide association study of aPAP in 198 patients and 395 control participants of Japanese ancestry. The common genetic variant, rs138024423 at 6p21, in the major-histocompatibility-complex (MHC) region was significantly associated with disease risk (Odds ratio [OR] = 5.2; P = 2.4 × 10-12). HLA fine-mapping revealed that the common HLA class II allele, HLA-DRB1*08:03, strongly drove this signal (OR = 4.8; P = 4.8 × 10-12), followed by an additional independent risk allele at HLA-DPβ1 amino acid position 8 (OR = 0.28; P = 3.4 × 10-7). HLA-DRB1*08:03 was also associated with an increased level of anti-GM-CSF antibody, a key driver of the disease (β = 0.32; P = 0.035). Our study demonstrated a heritable component of aPAP, suggesting an underlying genetic predisposition toward an abnormal antibody production.
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Affiliation(s)
- Saori Sakaue
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Allergy and Rheumatology, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
- Center for Data Sciences, Harvard Medical School, Boston, USA
- Divisions of Genetics and Rheumatology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, USA
| | - Etsuro Yamaguchi
- Division of Respiratory Medicine and Allergology, Department of Internal Medicine, School of Medicine, Aichi Medical University, Aichi, Japan
| | - Yoshikazu Inoue
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan
| | - Meiko Takahashi
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Jun Hirata
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
- Pharmaceutical Discovery Research Laboratories, TEIJIN PHARMA LIMITED, Hino, Japan
| | - Ken Suzuki
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Satoru Ito
- Division of Respiratory Medicine and Allergology, Department of Internal Medicine, School of Medicine, Aichi Medical University, Aichi, Japan
| | - Toru Arai
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan
| | - Masaki Hirose
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan
| | - Yoshinori Tanino
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takefumi Nikaido
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Toshio Ichiwata
- Department Respiratory Medicine, Tokyo Medical University, Tokyo, Japan
| | - Shinya Ohkouchi
- Occupational Health, Graduate School of Medicine, Tohoku University, Miyagi, Japan
| | - Taizou Hirano
- Respiratory Medicine, School of Medicine, Tohoku University, Miyagi, Japan
| | - Toshinori Takada
- Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Satoru Miyawaki
- Department of Neurosurgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan
| | - Shogo Dofuku
- Department of Neurosurgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan
| | - Yuichi Maeda
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Suita, Japan
- Laboratory of Immune Regulation, Department of Microbiology and Immunology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takuro Nii
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Suita, Japan
- Laboratory of Immune Regulation, Department of Microbiology and Immunology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Toshihiro Kishikawa
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kotaro Ogawa
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tatsuo Masuda
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kenichi Yamamoto
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kyuto Sonehara
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ryushi Tazawa
- Student Support and Health Administration Organization, Tokyo Medical and Dental University, Tokyo, Japan
| | - Konosuke Morimoto
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Masahiro Takaki
- Department of Infectious Diseases, Nagasaki University Hospital, Nagasaki University, Nagasaki, Japan
| | - Satoshi Konno
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masaru Suzuki
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Keisuke Tomii
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Atsushi Nakagawa
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tomohiro Handa
- Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kiminobu Tanizawa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Haruyuki Ishii
- Department of Respiratory Medicine, Kyorin University, Mitaka, Japan
| | - Manabu Ishida
- Department of Respiratory Medicine, Kyorin University, Mitaka, Japan
| | - Toshiyuki Kato
- Department of Respiratory Medicine and Allergology, Kariya Toyota General Hospital, Kariya, Japan
| | - Naoya Takeda
- Department of Respiratory Medicine and Allergology, Kariya Toyota General Hospital, Kariya, Japan
| | - Koshi Yokomura
- Department of Respiratory Medicine, Respiratory Disease Center, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Takashi Matsui
- Department of Respiratory Medicine, Respiratory Disease Center, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Masaki Watanabe
- Department of Pulmonary Medicine, Graduate School of Medical & Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Hiromasa Inoue
- Department of Pulmonary Medicine, Graduate School of Medical & Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Kazuyoshi Imaizumi
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Aichi, Japan
| | - Yasuhiro Goto
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Aichi, Japan
| | - Hiroshi Kida
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Tomoyuki Fujisawa
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takashi Yamada
- Department of Respiratory Medicine, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Yasuomi Satake
- Department of Respiratory Medicine, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Hidenori Ibata
- Department of Respiratory Medicine, National Hospital Organization Mie Chuo Medical Center, Tsu, Japan
| | - Nobuyuki Hizawa
- Department of Pulmonary Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hideki Mochizuki
- Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Atsushi Kumanogoh
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Suita, Japan
- Laboratory of Immunopathology, World Premier International Immunology Frontier Research Center (WPI-IFReC), Osaka University, Suita, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Japan
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Koh Nakata
- Division of Advanced Medical Development, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Tomomitsu Hirota
- Division of Molecular Genetics, the Jikei University School of Medicine, Research Center for Medical Science, Tokyo, Japan
| | - Mayumi Tamari
- Division of Molecular Genetics, the Jikei University School of Medicine, Research Center for Medical Science, Tokyo, Japan
| | - Yukinori Okada
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan.
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Japan.
- Laboratory of Statistical Immunology, World Premier International Immunology Frontier Research Center (WPI-IFReC), Osaka University, Suita, Japan.
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Suzuki T, Enomoto N, Horiike Y, Asada K, Shirai T, Suda T. Longitudinal lung involvement of systemic lupus erythematosus-related vasculitis and alveolar proteinosis-like reaction. Respirol Case Rep 2020; 8:e00559. [PMID: 32313654 PMCID: PMC7163719 DOI: 10.1002/rcr2.559] [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: 02/13/2020] [Revised: 03/23/2020] [Accepted: 03/23/2020] [Indexed: 11/12/2022] Open
Abstract
A 44-year-old woman with no symptoms was referred to our hospital for thorough examination of consolidation opacity on her left lung, which was growing for four years. She was diagnosed with systemic lupus erythematosus (SLE) at the age of 35 years and had been treated with prednisolone 10 mg/day. Physical examination and bronchoscopy revealed no abnormality including microbiological tests. She underwent surgical resection of the lung lesion. Lung biopsy specimens showed aggregation of lymphocytes with germinal centres and collagen deposition. Vasculitis and pulmonary alveolar proteinosis (PAP)-like reaction were also found. We diagnosed this lung opacity as an SLE-related lung lesion with vasculitis and PAP-like reaction. Lung involvement of SLE is scarce and long-term lung vasculitis and PAP-like reaction are extremely rare in patients with SLE. Clinicians should be aware of such SLE-related lung consolidation opacity that comprises lung vasculitis and PAP-like reaction.
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Affiliation(s)
- Takahito Suzuki
- Department of Respiratory MedicineShizuoka General HospitalShizuokaJapan
- Second Division, Department of Internal MedicineHamamatsu University School of MedicineHamamatsuJapan
| | - Noriyuki Enomoto
- Second Division, Department of Internal MedicineHamamatsu University School of MedicineHamamatsuJapan
- Health Administration CenterHamamatsu University School of MedicineHamamatsuJapan
| | - Yasuoki Horiike
- Second Division, Department of Internal MedicineHamamatsu University School of MedicineHamamatsuJapan
| | - Kazuhiro Asada
- Department of Respiratory MedicineShizuoka General HospitalShizuokaJapan
| | - Toshihiro Shirai
- Department of Respiratory MedicineShizuoka General HospitalShizuokaJapan
| | - Takafumi Suda
- Second Division, Department of Internal MedicineHamamatsu University School of MedicineHamamatsuJapan
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Sato S, Akasaka K, Ohta H, Tsukahara Y, Kida G, Tsumiyama E, Kusano K, Oba T, Nishizawa T, Kawabe R, Yamakawa H, Amano M, Matsushima H, Takada T. Autoimmune pulmonary alveolar proteinosis developed during immunosuppressive treatment in polymyositis with interstitial lung disease: a case report. BMC Pulm Med 2020; 20:84. [PMID: 32252718 PMCID: PMC7132862 DOI: 10.1186/s12890-020-1110-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 03/10/2020] [Indexed: 11/15/2022] Open
Abstract
Background Pulmonary alveolar proteinosis (PAP) is characterized by the accumulation of surfactant proteins within the alveolar spaces. Autoimmune PAP (APAP) caused by elevated levels of GM-CSF autoantibodies (GM-Ab) is very rarely associated with systemic autoimmune disease. Here we report a case of APAP manifested during immunosuppressive treatment for polymyositis with interstitial lung disease. Case presentation A 52-year-old woman treated at our hospital because of polymyositis with interstitial pneumonia had maintained remission by immunosuppressive treatment for 15 years. She had progressive dyspnea subsequently over several months with her chest CT showing ground-glass opacities (GGO) in bilateral geographic distribution. Her bronchoalveolar lavage fluid with cloudy appearance revealed medium-sized foamy macrophages and PAS-positive amorphous eosinophilic materials by cytological examination. We diagnosed her as APAP due to an increased serum GM-CSF autoantibody level. Attenuating immunosuppression failed to lead GGO improvement, but whole lung lavage (WLL) was effective in her condition. Conclusions PAP should be considered as one of the differential diseases when the newly interstitial shadow was observed during immunosuppressive treatment. WLL should be regarded as the treatment option for APAP concurred in connective tissue disease (CTD).
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Affiliation(s)
- S Sato
- Department of Respiratory Medicine, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-ku, Saitama, 330-8553, Japan.
| | - K Akasaka
- Department of Respiratory Medicine, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-ku, Saitama, 330-8553, Japan
| | - H Ohta
- Department of Respiratory Medicine, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-ku, Saitama, 330-8553, Japan
| | - Y Tsukahara
- Department of Respiratory Medicine, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-ku, Saitama, 330-8553, Japan
| | - G Kida
- Department of Respiratory Medicine, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-ku, Saitama, 330-8553, Japan
| | - E Tsumiyama
- Department of Respiratory Medicine, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-ku, Saitama, 330-8553, Japan
| | - K Kusano
- Department of Respiratory Medicine, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-ku, Saitama, 330-8553, Japan
| | - T Oba
- Department of Respiratory Medicine, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-ku, Saitama, 330-8553, Japan
| | - T Nishizawa
- Department of Respiratory Medicine, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-ku, Saitama, 330-8553, Japan
| | - R Kawabe
- Department of Respiratory Medicine, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-ku, Saitama, 330-8553, Japan
| | - H Yamakawa
- Department of Respiratory Medicine, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-ku, Saitama, 330-8553, Japan
| | - M Amano
- Department of Respiratory Medicine, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-ku, Saitama, 330-8553, Japan
| | - H Matsushima
- Department of Respiratory Medicine, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-ku, Saitama, 330-8553, Japan
| | - T Takada
- Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma, Japan
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6
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Yamasue M, Nureki SI, Usagawa Y, Ono T, Matsumoto H, Kan T, Kadota JI. Elevated Serum Anti-GM-CSF Antibodies before the Onset of Autoimmune Pulmonary Alveolar Proteinosis in a Patient with Sarcoidosis and Systemic Sclerosis. TOHOKU J EXP MED 2018; 243:77-83. [PMID: 28966213 DOI: 10.1620/tjem.243.77] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Pulmonary alveolar proteinosis (PAP) is characterized by the accumulation of periodic acid-schiff stain-positive lipoproteinaceous materials in the alveolar space due to impaired surfactant clearance by alveolar macrophage. Autoimmune PAP is the most common form of PAP, but rarely accompanies collagen disease or sarcoidosis. We report here a rare case of autoimmune PAP preceded by systemic sclerosis and sarcoidosis. A 64-year-old woman was admitted to our hospital for blurred vision, muscle weakness of extremities, Raynaud's phenomenon, and exertional dyspnea. We diagnosed her as having systemic sclerosis complicated with sarcoidosis. Chest computed tomography (CT) and transbronchial lung biopsy showed the findings of pulmonary fibrosis without PAP. We treated her with corticosteroid and intravenous cyclophosphamide therapy, followed by tacrolimus therapy. Thereafter, her symptoms improved except for exertional dyspnea, and she began to complain of productive cough thirteen months after corticosteroid and immunosuppressant therapy. On the second admission, a chest CT scan detected the emergence of crazy-paving pattern in bilateral upper lobes. Bronchoalveolar lavage (BAL) fluid with milky appearance and a lung biopsy specimen revealed acellular periodic acid-schiff stain-positive bodies. The serum titer of anti-granulocyte macrophage colony stimulating factor (GM-CSF) antibodies was elevated on first admission and remained high on second admission. We thus diagnosed her as having autoimmune PAP. Reducing the dose of immunosuppressive agents and repeating the segmental BAL resulted in the improvement of her symptoms and radiological findings. Immunosuppressant therapy may trigger the onset of autoimmune PAP in a subset of patients with systemic sclerosis and/or sarcoidosis.
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Affiliation(s)
- Mari Yamasue
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine
| | - Shin-Ichi Nureki
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine
| | - Yuko Usagawa
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine
| | - Tomoko Ono
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine
| | - Hiroyuki Matsumoto
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine
| | - Takamasa Kan
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine
| | - Jun-Ichi Kadota
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine
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7
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Imura Y, Yukawa N, Handa T, Nakashima R, Murakami K, Yoshifuji H, Ohmura K, Ishii H, Nakata K, Mimori T. Two cases of autoimmune and secondary pulmonary alveolar proteinosis during immunosuppressive therapy in dermatomyositis with interstitial lung disease. Mod Rheumatol 2016; 28:724-729. [PMID: 26872621 DOI: 10.3109/14397595.2016.1153443] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Interstitial lung disease (ILD) with dermatomyositis often requires intensive immunosuppressive therapy. Here, we report two cases of pulmonary alveolar proteinosis (PAP) in dermatomyositis with ILD. One case was secondary PAP, and the other was autoimmune PAP positive for the anti-granulocyte macrophage-colony-stimulating factor antibody. PAP arose during immunosuppressive therapy and symptoms ceased by attenuating immunosuppression. Exacerbation of pulmonary lesions during intensive immunosuppressive therapy may distinguish PAP from worsening ILD and attenuating immunosuppression should be considered.
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Affiliation(s)
| | | | - Tomohiro Handa
- b Department of Respiratory Medicine Graduate School of Medicine , Kyoto University , Sakyo-ku, Kyoto , Japan
| | - Ran Nakashima
- a Department of Rheumatology and Clinical Immunology
| | | | | | | | - Haruyuki Ishii
- c Department of Respiratory Medicine , Kyorin University School of Medicine , Mitaka , Japan , and
| | - Koh Nakata
- d Bioscience Medical Research Center , Niigata University , Chuoku, Niigata , Japan
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8
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Nagasawa J, Kurasawa K, Hanaoka R. Rituximab improved systemic lupus erythematosus-associated pulmonary alveolar proteinosis without decreasing anti-GM-CSF antibody levels. Lupus 2016; 25:783-4. [PMID: 26843507 DOI: 10.1177/0961203315627204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 12/21/2015] [Indexed: 11/17/2022]
Affiliation(s)
- J Nagasawa
- Clinical Immunology, Dokkyo Medical University, Tochigi, Japan Department of Rheumatology, Kamitsuga General Hospital, Tochigi, Japan
| | - K Kurasawa
- Clinical Immunology, Dokkyo Medical University, Tochigi, Japan
| | - R Hanaoka
- Department of Rheumatology, Kamitsuga General Hospital, Tochigi, Japan
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Ben-Dov I, Segel MJ. Autoimmune pulmonary alveolar proteinosis: Clinical course and diagnostic criteria. Autoimmun Rev 2014; 13:513-7. [DOI: 10.1016/j.autrev.2014.01.046] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 11/13/2013] [Indexed: 01/15/2023]
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