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Pulmonary Alveolar Proteinosis in Association With Household Exposure to Fibrous Insulation Material*

Josh W. McDonald, MD; Francisco Alvarez, MD; Cesar A. Keller, MD, FCCP
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*From the Department of Pathology (Dr. McDonald), and Department of Internal Medicine, Division of Pulmonary Medicine (Drs. Alvarez and Keller), St. Louis University Medical Center, St. Louis, MO.

Correspondence to: Josh W. McDonald, MD, Department of Pathology, St. Louis University Medical Center, 3635 Vista Ave at Grand Blvd, St. Louis, MO 63110-0250; e-mail: mcdonalj@sluh.edu



Chest. 2000;117(6):1813-1817. doi:10.1378/chest.117.6.1813
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We report the case of a 35-year-old woman who developed pulmonary alveolar proteinosis requiring multiple lavage treatments, in association with household exposure to ventilation system dust comprised at least partially by a cellulose fire-resistant fibrous insulation material. Scanning electron microscopy with energy-dispersive x-ray analysis documented the presence of spectral peaks consistent with the insulation material in transbronchial biopsy tissue. The patient showed symptomatic improvement once exposure to the insulation material had ceased. We believe that this case demonstrates an unusual association with pulmonary alveolar proteinosis. This case emphasizes the broad differential diagnosis for this histologic injury pattern and the need to thoroughly investigate environmental exposures in patients with unexplained pulmonary disease.

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