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Case Reports in Pulmonology
Volume 2018, Article ID 5202173, 5 pages
Case Report

Pulmonary Alveolar Proteinosis in Setting of Inhaled Toxin Exposure and Chronic Substance Abuse

1Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
2Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
3Divisions of Critical Care, Respirology, and General Internal Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada

Correspondence should be addressed to Asghar Naqvi;

Received 24 May 2017; Revised 15 August 2017; Accepted 20 September 2017; Published 23 January 2018

Academic Editor: Shinichiro Ohshimo

Copyright © 2018 Meirui Li et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Pulmonary alveolar proteinosis (PAP) is a rare lung disorder in which defects in alveolar macrophage maturation or function lead to the accumulation of proteinaceous surfactant in alveolar space, resulting in impaired gas exchange and hypoxemia. PAP is categorized into three types: hereditary, autoimmune, and secondary. We report a case of secondary PAP in a 47-year-old man, whose risk factors include occupational exposure to inhaled toxins, especially aluminum dust, the use of anabolic steroids, and alcohol abuse, which in mice leads to alveolar macrophage dysfunction through a zinc-dependent mechanism that inhibits granulocyte macrophage-colony stimulating factor (GM-CSF) receptor signalling. Although the rarity and vague clinical presentation of PAP can pose diagnostic challenges, clinician awareness of PAP risk factors may facilitate the diagnostic process and lead to more prompt treatment.