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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.
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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
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Van Luong H, Anh LV, Nguyen PT. Losing vigilance in diagnosing pulmonary alveolar microlithiasis: A report on four cases. J Clin Imaging Sci 2023; 13:32. [PMID: 37941922 PMCID: PMC10629246 DOI: 10.25259/jcis_56_2023] [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: 06/08/2023] [Accepted: 09/17/2023] [Indexed: 11/10/2023] Open
Abstract
Pulmonary alveolar microlithiasis (PAM) is a rare chronic lung disease characterized by calcium and phosphate deposition in the alveolar lumen throughout the parenchyma of both lungs, with predominance in the middle and lower lung fields. It is caused by mutations in the recessive gene, SLC34A2, on the autosomal chromosome. In this article, we characterize four cases of PAM and analyze the loss of diagnostic vigilance in two of them. Patients came to medical facilities with clinical manifestations such as cough, shortness of breath, chest pain, and fatigue. The initial diagnosis was unclear in two cases because the X-ray film's quality was not good enough and the medical staff had little experience in clinical and chest X-ray interpretations for PAM. The definitive diagnosis was based on a combination of high-resolution computed tomography (CT) and bronchoalveolar lavage fluid testing. In addition, chest X-ray and high-resolution CT enable the assessment of the stage, progression, and severity of the disease. There is currently no specific treatment for PAM other than lung transplantation.
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Affiliation(s)
- Hoang Van Luong
- Department of Diagnostic Imaging, National Lung Hospital, Hanoi, Vietnam
| | - Lam Viet Anh
- Department of Medicine, College of Health Sciences, Vin University, Hanoi, Vietnam
| | - Pham Thanh Nguyen
- Department of Anatomy, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
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Batesh D, Habash R, Alhaffar MN, Almani I. Pulmonary alveolar microlithiasis: a rare case report from Syria. Ann Med Surg (Lond) 2023; 85:4566-4569. [PMID: 37663718 PMCID: PMC10473359 DOI: 10.1097/ms9.0000000000001060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/01/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction and importance This report presents a case of pulmonary alveolar microlithiasis (PAM), a rare disease characterized by dry cough, dyspnea, and chest pain. Most reported cases are from Turkey, with a frequency of 1.85 in 1 million, and there are no documented cases from Syria in the medical literature. Here, we present the first case report from Syria. Case presentation A 56-year-old male patient complained of a dry cough that began 4 years ago and had worsened over the last 3 months, along with a grade I dyspnea. Chest radiograph showed a 'sandstorm-like' appearance, and a computed tomography scan revealed diffuse ground-glass opacities. To confirm the diagnosis, we performed a transbronchial lung biopsy and bronchial washing. Histopathology results revealed interalveolar calcification consistent with PAM. The diagnosis was based on radiological and lung biopsy findings. The patient received oxygen therapy, resulting in significant improvement. We recommended the use of a home oxygen machine for episodes of shortness of breath. Clinical discussion PAM is an autosomal recessive disease caused by a mutation in the SLC34A2 gene (solute carrier family 34, member 2 gene), characterized by intra-alveolar airspace microliths called calcospherites. Miliary tuberculosis should be considered a differential diagnosis. Conclusions The disease progresses slowly and is often diagnosed incidentally. Lung transplantation remains the only effective treatment.
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Affiliation(s)
| | | | - Mhd Nabih Alhaffar
- Department of Pulmonary Medicine, Damascus University, Al-Mouwasat University Hospital, Damascus, Syria
| | - Imad Almani
- Department of Pulmonary Medicine, Damascus University, Al-Mouwasat University Hospital, Damascus, Syria
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Jönsson ÅLM, Hilberg O, Simonsen U, Christensen JH, Bendstrup E. New insights in the genetic variant spectrum of SLC34A2 in pulmonary alveolar microlithiasis; a systematic review. Orphanet J Rare Dis 2023; 18:130. [PMID: 37259144 DOI: 10.1186/s13023-023-02712-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/30/2023] [Indexed: 06/02/2023] Open
Abstract
Pulmonary alveolar microlithiasis (PAM) is a rare autosomal recessive lung disease caused by variants in the SLC34A2 gene encoding the sodium-dependent phosphate transport protein 2B, NaPi-2b. PAM is characterized by deposition of calcium phosphate crystals in the alveoli. Onset and clinical course vary considerably; some patients remain asymptomatic while others develop severe respiratory failure with a significant symptom burden and compromised survival. It is likely that PAM is under-reported due to lack of recognition, misdiagnosis, and mild clinical presentation. Most patients are genetically uncharacterized as the diagnostic confirmation of PAM has traditionally not included a genetic analysis. Genetic testing may in the future be the preferred tool for diagnostics instead of invasive methods. This systematic review aims to provide an overview of the growing knowledge of PAM genetics. Rare variants in SLC34A2 are found in almost all genetically tested patients. So far, 34 allelic variants have been identified in at least 68 patients. A majority of these are present in the homozygous state; however, a few are found in the compound heterozygous form. Most of the allelic variants involve only a single nucleotide. Half of the variants are either nonsense or frameshifts, resulting in premature termination of the protein or decay of the mRNA. There is currently no cure for PAM, and the only effective treatment is lung transplantation. Management is mainly symptomatic, but an improved understanding of the underlying pathophysiology will hopefully result in development of targeted treatment options. More standardized data on PAM patients, including a genetic diagnosis covering larger international populations, would support the design and implementation of clinical studies to the benefit of patients. Further genetic characterization and understanding of how the molecular changes influence disease phenotype will hopefully allow earlier diagnosis and treatment of the disease in the future.
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Affiliation(s)
- Åsa Lina M Jönsson
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark.
- Department of Biomedicine, Aarhus University, Aarhus, Denmark.
| | - Ole Hilberg
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
- Department of Medicine, Lillebaelt Hospital, Vejle, Denmark.
| | - Ulf Simonsen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | | | - Elisabeth Bendstrup
- Centre for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
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Pulmonary Alveolar Microlithiasis and Rheumatoid Arthritis: A Case Report and Review of the Literature. Case Rep Rheumatol 2021; 2021:8811507. [PMID: 34194863 PMCID: PMC8184319 DOI: 10.1155/2021/8811507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 05/20/2021] [Indexed: 11/17/2022] Open
Abstract
Pulmonary alveolar microlithiasis is a rare autosomal recessive condition that is characterized by the formation of excessive calcium phosphate microliths in the alveoli. Most patients are diagnosed in adulthood due to the slow progression of the disease. Children with this disease are asymptomatic, and changes in the lung parenchyma are usually discovered incidentally. The diagnosis is made by the combination of a positive chest imaging and histological examination. Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease characterized by chronic seropositive symmetrical inflammatory polyarthritis with numerous extra-articular manifestations. It targets the lining of the synovial membranes, frequently affects females more than males, and is treated with the disease-modifying antirheumatic drugs (DMARDs). If left untreated, it leads to increased morbidity, mortality, and socioeconomic burdens. In this case, we report a 19-year-old young man who presented with clinical and radiographic features of PAM associated with RA.
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Bendstrup E, Jönsson ÅLM. Pulmonary alveolar microlithiasis: no longer in the stone age. ERJ Open Res 2020; 6:00289-2020. [PMID: 32964001 PMCID: PMC7487355 DOI: 10.1183/23120541.00289-2020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/16/2020] [Indexed: 01/18/2023] Open
Abstract
Pulmonary alveolar microlithiasis (PAM) is a rare parenchymal lung disease caused by variants in the SCL34A2 gene and characterised by the accumulation of intra-alveolar microliths. PAM has been reported in fewer than 1100 cases throughout the world. It is an autosomal recessive hereditary disease and often associated with consanguinity. Progress with respect to the genetic background and pathophysiology has resulted in an increased understanding of the disease in recent years. Until now, 30 genetic different SLC34A2 variants have been reported, which all are considered significant for disease development. There is no sex difference and the majority of cases are diagnosed at the age of 30–40 years. Many patients are asymptomatic and the diagnosis is made at random. When symptomatic, dyspnoea, cough, chest pain and fatigue are common complaints. The diagnosis of PAM can confidently be based on typical radiographic findings and genetic testing proving rare biallelic SCL34A2 gene variants. Bronchoalveolar lavage and histopathology may show microliths. There is no disease-specific treatment and management is supportive. Lung transplantation should be considered in advanced cases. Pulmonary alveolar microlithiasis is a rare, autosomal recessive lung disease. Formation of alveolar microliths is caused by SCL34A2 variants. The prognosis is severe; respiratory failure is common. Lung transplantation is the only effective therapy.https://bit.ly/3dpkbRw
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Affiliation(s)
- Elisabeth Bendstrup
- Center for Rare Lung Diseases, Dept of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
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Al Umairi R, Al Lawati F, Al-Riyami M, Al Kindi F, Kamona A, Al Busaidi F, Al Lawati N, Al Lawati A, Habibulla Z. Pulmonary Alveolar Microlithiasis: A Case Report. Oman Med J 2020; 35:e115. [PMID: 32328294 PMCID: PMC7171818 DOI: 10.5001/omj.2020.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 01/06/2019] [Indexed: 12/19/2022] Open
Abstract
Pulmonary alveolar microlithiasis (PAM) is a rare disease caused by a mutation in the SLC34A2 gene encoding the type IIb sodium phosphate cotransporter in alveolar type II cells. This results in the formation and accumulation of calcium phosphates crystals in the alveoli. Early in the disease, most patients are asymptomatic or might experience mild symptoms. However, in some patients, PAM can progress resulting in pulmonary fibrosis, cor pulmonale, and respiratory failure. We report the case of a 33-year-old Omani male who was referred to our institute with a history of fever and shortness of breath. A chest radiograph revealed bilateral dense consolidation. Chest computed tomography showed bilateral dense interlobular thickening and extensive consolidations with a lower lung predominance. Our findings were highly suggestive of PAM. The diagnosis was confirmed by bronchoalveolar lavage.
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Affiliation(s)
| | | | | | | | - Atheel Kamona
- Department of Radiology, Royal Hospital, Muscat, Oman
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Pulmonary Alveolar Microlithiasis: An Isolated Case in a Hispanic Male. Case Rep Pathol 2020; 2020:6247920. [PMID: 32411490 PMCID: PMC7204375 DOI: 10.1155/2020/6247920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 03/16/2020] [Indexed: 11/25/2022] Open
Abstract
Pulmonary alveolar microlithiasis (PAM) is an uncommon hereditary lung disease characterized by widespread deposition of calcium phosphate microliths within the alveolar spaces. It is considered an autosomal recessive disease with a mutation in a gene encoding a sodium phosphate cotransporter. The imaging findings in the early phase of disease can be mistaken for miliary tuberculosis or sarcoidosis. However, the classic radiologic findings in the later phases of disease show numerous opacities causing a “snowstorm” appearance to the lungs that corresponds with widespread deposition of microliths throughout the lung parenchyma. Although the disease often progresses over a slow time course, there are no effective therapies, and bilateral lung transplantation is recommended when there are increasing oxygen requirements or evidence of pulmonary hypertension.
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Pulmonary alveolar microlithiasis: A report of two unique cases. Respir Med Case Rep 2019; 29:100980. [PMID: 31890557 PMCID: PMC6928350 DOI: 10.1016/j.rmcr.2019.100980] [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: 11/13/2019] [Revised: 12/08/2019] [Accepted: 12/09/2019] [Indexed: 12/16/2022] Open
Abstract
Pulmonary alveolar microlithiasis (PAM) is an inherited autosomal recessive disease. PAM is classically characterized by calcium phosphate deposition within alveolar airspaces due to SLC34A2 (solute carrier family 34 member 2) gene mutation located on chromosome 4p15.2. Such cellular genetic mutation would lead to a defect in the sodium-phosphate transporter channel located in alveolar epithelial cells type-II. Ultimately, it would result in a malfunction of alveolar epithelial cells and the failure of these cells to clear-up the released phosphorous particles in the cellular surfactant recycling. PAM is usually diagnosed in adulthood, frequently notable in the third and fourth decades of life, occasionally can be associated with more severe clinical presentation and radiological findings. Nevertheless, the disease could manifest itself in the pediatric age group, which either shows non-specific signs and symptoms or be exclusively asymptomatic. Histopathological examination is the gold standard for the PAM diagnosis. Genetic counseling and testing might benefit the patient's family members. Herein, we present 2 cases of PAM in the pediatric age group, along with their clinical history, presentation, radiological studies, and histopathology findings, as well as a brief literature review.
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Ramezani M, Aminparast Z, Sadeghi M. Pulmonary alveolar microlithiasis and interstitial pneumonitis: a case report of the west of Iran. Biomedicine (Taipei) 2019; 9:28. [PMID: 31724942 PMCID: PMC6855191 DOI: 10.1051/bmdcn/2019090428] [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: 03/07/2019] [Accepted: 05/02/2019] [Indexed: 11/24/2022] Open
Abstract
Pulmonary alveolar microlithiasis (PAM) is a rare disease with autosomal recessive inheritance. Herein, a 20-year-old lady referred to the hospital with a dry cough for two years. The chest X-ray findings were bilateral reticulonodular opacities in both lungs and honeycomb appearance suspicious for miliary tuberculosis and idiopathic pulmonary fibrosis. A wedge biopsy of lung showed that there were several intraalveolar laminated concretions in the pathology report compatible with pulmonary alveolar microlithiasis and interstitial infiltration of lymphocytes and neutrophils compatible with interstitial pneumonitis. PAM is a rare progressive disease with the production of microliths in pulmonary alveoli. The pathologist, radiologist, and clinician should be familiar with this entity for diagnosis and appropriate management. The family of the patient especially siblings must be evaluated for earlier diagnosis.
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Affiliation(s)
- Mazaher Ramezani
- Molecular Pathology Research Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Zahra Aminparast
- Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Sadeghi
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran - Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Alrossais NM, Alshammari AM, Alrayes AM, Mohammad N, Al-Amoodi MJH, Almutairi AM, Alsuhaymi AO, Alhadid DA, Alhammad FA, Ouf NH, Ahmed MH, Saleh W, AlAmodi AA. Pulmonary Hypertension and Polycythemia Secondary to Pulmonary Alveolar Microlithiasis Treated with Sequential Bilateral Lung Transplant: A Case Study and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1114-1119. [PMID: 31352464 PMCID: PMC6683309 DOI: 10.12659/ajcr.911045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Patient: Male, 49 Final Diagnosis: Pulmonary alveolar microlithiasis Symptoms: Coughing • shortness of breath Medication: — Clinical Procedure: — Specialty: Surgery
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Affiliation(s)
| | - Abdullah M Alshammari
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,Department of Thoracic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Najwa Mohammad
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Mohamed J H Al-Amoodi
- The School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | | | | | - Daeya A Alhadid
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Nida H Ouf
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Mohammed H Ahmed
- Department of Thoracic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.,Department of Cardiothoracic Surgery, Ain Shams University, Cairo, Egypt
| | - Waleed Saleh
- Department of Thoracic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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