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Pulmonary alveolar proteinosis

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The patient was a 2-year-old boy who was hospitalised due to dyspnoea with primary clinical impression of pneumonia. Laboratory tests were normal except mild leucocytosis (white cell count=13.09×109/L, haemoglobin=155 g/L, platelet=378×109 /L, blood sugar=90 mg/dL, blood urea nitrogen=10 mg/dL, creatinine=0.5 mg/dL, sodium=140 meq/L, potassium=5 meq/L). Blood culture, urine culture and bronchoalveolar lavage culture for tuberculosis, fungi and bacteria were negative. Chest X-ray showed bilateral consolidation which was more prominent at hilar regions (figure 1A). Chest high resolution computerised tomography revealed bilateral septal thickening and ground glass opacities (figure 1B). Histopathology findings of transbronchial biopsy showed a dense granular eosinophilic material in alveoli with oval bodies and cholesterol cleft (figure 1C). The eosinophilic material was positive in periodic acid schiff with diastase (figure 1D).

Figure 1

(A) Chest X-ray …

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