SHM Converge Scientific Abstract ePoster Gallery-Progressive Dyspnea in a Post-Transplant Patient: A Rare Case of Secondary Pulmonary Alveolar Proteinosis

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This case describes a 76-year-old woman with progressive exertional dyspnea, weight gain, and edema seven years after an allogeneic stem cell transplant for acute myeloid leukemia, complicated by chronic graft-versus-host disease and other comorbidities. Her evaluation showed diffuse bilateral ground-glass opacities on chest CT, reduced pulmonary function with a marked decline in FEV1, FVC, and DLCO, and right-sided cardiac changes on echocardiogram. Bronchoalveolar lavage was negative for infection or malignancy, but diagnosis remained unclear until cryobiopsy demonstrated PAS-positive intra-alveolar proteinaceous material, confirming pulmonary alveolar proteinosis (PAP). GM-CSF antibody testing was negative, supporting secondary PAP rather than autoimmune disease.<br /><br />The report highlights that secondary PAP is associated with hematologic malignancies, stem cell transplantation, and immunosuppression. Because imaging and bronchoscopy are often nonspecific, a high index of suspicion is needed, and lung biopsy may be required for definitive diagnosis. Initial treatment in this case included inhaled GM-CSF while testing was pending, but the patient continued to worsen, with declining DLCO and progressive CT abnormalities. She ultimately underwent whole lung lavage, which led to significant symptomatic improvement.<br /><br />The key message is that in patients with a history of hematologic malignancy or transplant who develop unexplained progressive dyspnea and diffuse ground-glass opacities, secondary PAP should be considered early. Prompt recognition, multidisciplinary evaluation, and timely intervention are essential to reduce the risk of respiratory failure and improve outcomes.

Asset Subtitle

Aissatou Bah

Meta Tag

Author List Aissatou Bah, Nadir Bhuiyan, Shane Fuentes

Category Clinical Vignettes

Concept Secondary Pulmonary Alveolar Proteinosis

Concept Dyspnea

Concept Ground-Glass Opacities

Concept Anti-GM-CSF Antibodies

Distinguished Non-Finalist

Presenter Organization Mayo Clinic

Presenting Author Aissatou Bah

Track Adult

Keywords

pulmonary alveolar proteinosis

secondary PAP

allogeneic stem cell transplant

acute myeloid leukemia

chronic graft-versus-host disease

ground-glass opacities

cryobiopsy

GM-CSF antibody negative

whole lung lavage

progressive dyspnea

Secondary Pulmonary Alveolar Proteinosis

Dyspnea

Ground-Glass Opacities

Anti-GM-CSF Antibodies