Pulmonary alveolar proteinosis in a man with prolonged cotton dust exposure

Abstract

A 59-year-old man presented with severe paroxysms of cough associated with dyspnea. His CT scan showed diffuse bilateral ground glass opacifications. His bronchoalveolar lavage fluid was consistent with pulmonary alveolar proteinosis. Transbronchial biopsy, microbiological studies, and cytology did not identify any alternative diagnosis. The patient had a history of working as a textile loom technician for thirty-one years and had significant exposure to cotton dust. He responded well to whole lung lavage with improvement of symptoms, gas exchange, and CT scan. This patient represents the third reported case of pulmonary alveolar proteinosis associated with cotton dust exposure. We suggest that cellulose might be useful in animal models of pulmonary alveolar proteinosis.