Pulmonary Alveolar Proteinosis Secondary to Chronic Ethylene Oxide Occupational Inhalation

Year 2024, Volume: 26 Issue: 1, 88 - 90, 30.04.2024

Fanny Fachrucha , Rossy Ardhia Pramesti , Mia Elhidsi , Sita Andarini , Prasenohadi Prasenohadi , Feni Fitriani Taufik , Widya Sri Hastuti , Romi Beginta , Meilania Saraswati

https://doi.org/10.18678/dtfd.1377199

Abstract

In this case report, a 40-year-old male patient with a persistent and productive cough lasting over 2 weeks, accompanied by dyspnea, who received an anti-tuberculosis drug regimen for 12 months without any clinical improvement at a different hospital before being referred to Persahabatan Central General Hospital was presented. In-depth clinical, and radiological investigations, the periodic acid-Schiff (PAS)-positive related to pulmonary alveolar proteinosis (PAP) confirmed through transbronchial biopsy (TBB). PAP is a rare lung disease with exceptionally low prevalence and incidence, Notably, the patient’s occupational environment played a crucial role in the diagnosis, as we identified occupational PAP secondary to chronic inhalation of ethylene oxide in a poorly ventilated work setting and inadequate respiratory protection. The patient was administered inhaled filgrastim (1 vial) at four intervals over 30 days, yielding favorable and satisfactory clinical as well as radiological outcomes.

Keywords

Chronic Ethylene Oxide, Pulmonary Alveolar Proteinosis, Pulmonary Lavage, Transbronchial Biopsy

Mesleki olarak Kronik Etilen Oksit İnhalasyonuna Sekonder Pulmoner Alveolar Proteinozis

Abstract

Bu olgu sunumunda, 2 haftadan uzun süredir devam eden inatçı ve prodüktif öksürüğün yanı sıra nefes darlığı şikayeti olan, Persahabatan Merkez Genel Hastanesi'ne sevk edilmeden önce farklı bir hastanede 12 ay boyunca anti-tüberküloz ilaç tedavisi alan ve herhangi bir klinik iyileşme göstermeyen 40 yaşında bir erkek hasta sunulmaktadır. Ayrıntılı klinik ve radyolojik incelemelerde, pulmoner alveoler proteinozis (PAP) ile ilişkili periyodik asit-Schiff (PAS) pozitifliği, transbronşiyal biyopsi (TBB) ile doğrulandı. PAP son derece düşük prevalansı ve insidansı olan nadir bir akciğer hastalığıdır. Yetersiz havalandırılan bir çalışma ortamında ve yetersiz solunum korumasıyla kronik etilen oksit inhalasyonuna ikincil olarak mesleki PAP belirlediğimiz hastada, özellikle hastanın mesleki ortamı tanıda çok önemli bir rol oynadı.
Hastaya 30 gün boyunca dört aralıkla inhale filgrastim (1 şişe) uygulandı ve olumlu ve tatmin edici klinik ve radyolojik sonuçlar elde edildi.

Keywords

Kronik Etilen Oksit, Pulmoner Alveoler Proteinözis, Pulmoner Lavaj, Transbronşiyal Biyopsi

References

• Carrington JM, Hershberger DM. Pulmonary alveolar proteinosis. 2022 Jul 25. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.
• Borie R, Danel C, Debray MP, Taille C, Dombret MC, Aubier M, et al. Pulmonary alveolar proteinosis. Eur Respir Rev. 2011;20(120):98-107.
• Hwang JA, Song JH, Kim JH, Chung MP, Kim DS, Song JW, et al. Clinical significance of cigarette smoking and dust exposure in pulmonary alveolar proteinosis: a Korean national survey. BMC Pulm Med. 2017;17(1):147.
• Raúl Rey D, González JA. Pulmonary alveolar proteinosis secondary to chronic chlorine occupational inhalation. J Lung Pulm Respir Res. 2018;5(3):100-3.
• Li M, Alowami S, Schell M, Davis C, Naqvi A. Pulmonary alveolar proteinosis in setting of inhaled toxin exposure and chronic substance abuse. Case Rep Pulmonol. 2018;2018:5202173.
• atsdr.cdc.gov [Internet]. Agency for Toxic Substances and Disease Registry (ATSDR). ATSDR MMG for ethylene oxide. [Updated: 2023 Apr; Cited: 2024 Jan 24]. Available from: https://www.atsdr.cdc.gov/mhmi/ mmg137.pdf
• Ndlovu N, Ghammo H, Tau M, Thomas B, Fathuse T, Ekpebegh C, et al. Pulmonary alveolar proteinosis diagnosis after re-evaluation for chronic cough unresponsive to empirical antituberculosis therapy. Afr J Thoracic Crit Care Med. 2023;29(4):e1186.
• Kawkitinarong K, Sittipunt C, Wongtim S, Udompanich V. Pulmonary alveolar proteinosis: a report of seven patients from King Chulalongkorn Memorial Hospital. J Med Assoc Thai. 2005;88(Suppl 4):S312-6.
• Trapnell BC, Whitsett JA, Nakata K. Pulmonary alveolar proteinosis. N Engl J Med. 2003;349(26):2527-39.
• Pamuk GE, Turgut B, Vural O, Demir M, Hatipoglu O, Unlu E, et al. Pulmonary alveolar proteinosis in a patient with acute lymphoid leukemia regression after G-CSF therapy. Leuk Lymphoma. 2003;44(5):871-4.
• Lazarus HM, Gale RP. G-CSF and GM-CSF are different: Which one is better for COVID-19. Acta Haematol. 2021;144(4):355-9.