TY - JOUR A2 - Drouet, Christian AU - Keske, Aysenur AU - Destrampe, Eric M. AU - Barksdale, Byron AU - Rose, William N. PY - 2022 DA - 2022/01/30 TI - Pulmonary Alveolar Proteinosis Refractory to Plasmapheresis and Rituximab despite GM-CSF Antibody Reduction SP - 2104270 VL - 2022 AB - We share our experience of a patient with pulmonary alveolar proteinosis who was refractory to plasmapheresis and rituximab despite a significant reduction in the offending antibody. He presented with shortness of breath, fevers, chills, and sweats for 4 months. He was diagnosed with autoimmune PAP based on typical radiology findings, bronchoalveolar fluid analysis, and elevated anti-GM-CSF levels. Given his limited improvement with whole lung lavage and inhaled GM-CSF therapy, he underwent two series of plasmapheresis. Series one was 5 procedures in 6 days, and series two was 5 procedures in 9 days followed by rituximab. These did not appear to provide any lasting clinical benefit in the year after plasmapheresis despite a marked decrease in serum anti-GM-CSF levels. However, about a year after plasmapheresis, he went into remission and has not required any treatment. SN - 2090-6609 UR - https://doi.org/10.1155/2022/2104270 DO - 10.1155/2022/2104270 JF - Case Reports in Immunology PB - Hindawi KW - ER -