Unravelling A Rare Diagnosis: Pulmonary Alveolar Proteinosis

Pulmonary alveolar proteinosis (PAP) is a rare disorder characterized by abnormal accumulation of surfactant within the alveoli, leading to impaired gas exchange and progressive respiratory symptoms. We report a 40-year-old stone grinder presenting with chronic cough, dyspnea, weight loss and hypoxemia. High-resolution computed tomography showed bilateral ground-glass opacities, while bronchoalveolar lavage (BAL) yielded characteristic milky fluid. Cytological examination demonstrated PAS-positive eosinophilic material with foamy macrophages, confirming secondary PAP related to silica exposure. Lung biopsy was not feasible because of the patient's condition. Whole lung lavage resulted in marked clinical, radiological and oxygenation improvement, highlighting BAL cytology's diagnostic value.