rifampin and Pulmonary-Alveolar-Proteinosis

The patient was a 32-year-old man in whom pulmonary tuberculosis had occurred 5 years after the presumptive onset of pulmonary alveolar proteinosis. A diagnosis of pulmonary tuberculosis was made by sputum smears positive for acid-fast bacilli. Computer tomography of the chest showed ground glass opacities, consolidation and cavitation. Rifampicin, isoniazid and ethambutol were given daily, and streptomycin three times a week. Serial chest radiographs revealed progressive clearing not only of the new but also of the old lung infiltrates thought to be due to pulmonary alveolar proteinosis. Serum LDH and CEA returned to normal values. This case indicates the possibility of improving pulmonary alveolar proteinosis by tuberculosis infection or antituberculosis therapy.

Topics: Adult; Antitubercular Agents; Drug Therapy, Combination; Ethambutol; Humans; Isoniazid; Male; Pulmonary Alveolar Proteinosis; Remission Induction; Rifampin; Streptomycin; Tuberculosis, Pulmonary

A case of Pulmonary Alveolar Proteinosis (PAP), in association with tuberculosis, is described in a 35-year-old diabetic patient. Lung biopsy showed an intra-alveolar accumulation of PAS-positive material, and multifocal granulomas compatible with tuberculosis. The bronchoalveolar culture was positive for Mycobacterium tuberculosis. PAP results from an imbalance of the mechanisms that regulate the homeostasis of the surfactant, where specific proteins are involved, especially SP-A and SP-D, the cytokines, IL-10 and GM-CSF, in addition to alveolar macrophages and type-II pneumocytes. Chemotaxis and phagocytic capacity are reduced. PAP and diabetes share several immunological disfunctions that may increase the risk for tuberculosis. Although there are no controlled studies, the diagnosis of PAP in diabetic patients with tuberculosis must be considered.

Topics: Adult; Diabetes Complications; Female; Humans; Isoniazid; Mycobacterium tuberculosis; Pulmonary Alveolar Proteinosis; Pyrazinamide; Rifampin; Tuberculosis, Pulmonary

Topics: Aged; Anti-Bacterial Agents; Antitubercular Agents; Bronchoalveolar Lavage; Drug Therapy, Combination; Ethambutol; Humans; Isoniazid; Male; Pulmonary Alveolar Proteinosis; Rifampin; Tuberculosis, Pulmonary

Topics: Antitubercular Agents; Humans; Isoniazid; Male; Middle Aged; Pulmonary Alveolar Proteinosis; Rifampin; Streptomycin; Tuberculosis, Pulmonary