Pulmonary alveolar proteinosis diagnosed in pregnancy and managed with whole-lung lavage

A 29-year-old woman presented with dyspnea, fatigue, and chills during the first trimester of pregnancy. She did not respond to empiric antibiotic therapy for bronchitis and was subsequently hospitalized with worsening respiratory symptoms and hypoxemia. During this hospitalization, the patient underwent open lung biopsy and was diagnosed with pulmonary alveolar proteinosis (PAP). A therapeutic trial with granulocyte-macrophage colony-stimulating factor proved ineffective. Later in her pregnancy, therapeutic sequential whole-lung lavage was performed owing to her worsening dyspnea and hypoxemia. Cryptococcus neoformans grew in culture from her lavage fluid. Whole-lung lavage resulted in clinical improvement and she was treated with a course of amphotericin B for her cryptococcal lung infection. A healthy male infant was delivered at term without complications. Our case is another example of the feasibility and safety of whole-lung lavage in a symptomatic pregnant woman with PAP, and also demonstrates the need for a high index of suspicion for secondary infection in PAP.