Pulmonary Alveolar Proteinosis and Occupational Exposure: Case Analysis

Abstract

Pulmonary alveolar proteinosis (PAP), an extremely rare disease, is potentially caused by occupational exposure. Identifying the occupational etiology may help to avoid recurrence of the disease by refraining from further work exposure. In this study, PAP cases with pathological confirmation in a tertiary medical center diagnosed between 1995 and 2006 were identified through a review of medical records. A descriptive analysis of relevant characteristics was carried out and the relationship between PAP and occupational exposure was explored. In total, three male and two female patients were identified. Dyspnea on exertion and a cough were the main symptoms. Bronchoalveolar lavage was performed in all patients and proved to be an effective treatment. Two men were exposed to silica sand at work. One was a foundry worker who became ill after 20 years of work, and two of his coworkers presented with similar symptoms. The other male patient was a sandblaster who developed symptoms within three months of starting work. As silica-like birefringent substances were found in the lung tissues of these two men, their PAP was highly suspected to be work-related. As for the other three patients, significant exposure could not be identified either at work or at home. The causes of their diseases remained unclear. In conclusion, occupational exposure is one possible cause of PAP. A detailed occupational history helps to identify potential causes and to avoid further exposure, so that recurrence of the disease can be prevented.