Rapidly Progressive Pulmonary Alveolar Proteinosis Following Cryptococcal Infection: Case Report and Literature Review

Pulmonary alveolar proteinosis (PAP) is a rare disease caused by accumulation of sediment within alveoli. Cryptococcosis a fungal infection typically presenting with central nervous system (CNS) and pulmonary disease. Granulocyte-macrophage colony-stimulating factor antibodies are associated with PAP and elevated risk of cryptococcosis. The usual interval from cryptococcal infection to the onset of PAP spans several years. Here, we describe a case of a 24-year-old Aboriginal Australian woman with no prior medical history, who presented with seizures from CNS cryptococcosis, and subsequently developed rapidly progressive hypoxic respiratory failure secondary to autoimmune-PAP within weeks of initial presentation. The rate and degree of respiratory failure necessitated urgent bilateral whole lung lavage (WLL) whilst on venovenous-extracorporeal membrane oxygenation. Our report hopes to increase recognition of PAP in the Australian population, document the utility and risks of bilateral WLL in the critically unwell patient and provide an updated literature review of PAP and cryptococcal infection.