Neurological Consequences Stemming From Pulmonary Alveolar Proteinosis and Opportunistic Infections

Abstract

Pulmonary alveolar proteinosis (PAP) is a rare lung disease in which macrophage dysfunction causes a nonproductive cough and progressive dyspnea. However, mortality in roughly 20% of these patients is due to opportunistic infections by fungal pathogens, Nocardia spp, and mycobacteria. In this case, we discuss a 52-year-old African American male who presented with a month-long history of progressively worsening dyspnea and frequent nonproductive cough. The patient’s medical history was significant for a diagnosis of cavitary pneumonia one year ago. He was treated for community acquired pneumonia. A week later, the patient presented back to the emergency room with seizures and an altered mental status with a lesion appearing on head CT. The brain lesion was removed and tested positive for Nocardia. However, the diagnosis of PAP was not considered at that time. This case is significant because PAP should be considered as a differential when a patient presents with dyspnea, cough, and opportunistic infection. If the patient was diagnosed with PAP at his initial visit, the Nocardia infection could have been found and treated conservatively before it progressed to seizures and an emergent surgery.