Abstract

OSEJO-BETANCOURT, Miguel; MORENO-RAMIREZ, Carlos Ernesto  and  CHAPARRO-MUTIZ, Pedro. Whole Lung Lavage Protocol at Hospital Santa Clara of Bogotá: Presentation of a Patient with Resistant Pulmonary Alveolar Proteinosis. Rev. am. med. respir. [online]. 2022, vol.22, n.4, pp.445-453. ISSN 1852-236X.  http://dx.doi.org/10.56538/ramr.fpks7802.

Pulmonary alveolar proteinosis is a clinical entity characterized by the accumulation of proteinaceous material, rich in surfactant, mediated by reduced clearance by alveolar macrophages. In adult patients, it is commonly associated with autoimmune phenomena resulting in a deficiency of the granulocyte-macrophage colony stimulating factor, which implies alterations in cell maturation and dysfunction, causing a decrease in surfactant degradation and its accumulation in the alveolar space. Its diagnosis poses a challenge to the clinician, based on the findings of pulmonary function tests and the crazy paving pattern of the high-resolution computed tomography of the chest, and is confirmed by obtaining the proteinaceous material in the bronchoalveolar lavage. Given its rarity, the ideal treatment remains to be elucidated, with whole lung lavage currently being the cor nerstone of treatment. We report an anecdotal case of a 41-year-old female patient suf fering from pulmonary alveolar proteinosis since 2011, who has required multiple whole lung lavages, with poor response to these, with persistent dyspnea and supplemental oxygen requirement even though she has performed the procedure, but with a progres sive tendency towards improvement in the last 2 years. The lavage technique is not com pletely standardized and its use in Latin America is still limited, which is why we publish the protocol used in the Hospital Santa Clara of Bogotá, Colombia.

Keywords : Pulmonary alveolar proteinosis; Pulmonology; Protocol; Whole lung lavage; Rare diseases.

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