A case of uncomplicated pulmonary alveolar proteinosis evolving to pulmonary fibrosis.

Pulmonary alveolar proteinosis (PAP) is a rare syndrome characterised by intra-alveolar accumulation of surfactant components and cellular debris, with minimal interstitial inflammation or fibrosis. Since surfactant accumulates abnormally, a disturbance in the normal pathway of surfactant production, metabolism, recycling or degradation has been postulated. This disease has a variable clinical course: from spontaneous resolution to respiratory failure and death due to disease progression or superimposed infections. PAP leading to pulmonary fibrosis is rarely seen, and few case reports describe this association. Here, we describe the case of a patient with a diagnosis of PAP confirmed by open lung biopsy, who developed interstitial pulmonary fibrosis years after disease onset.

Periodic acid-Schiff-negative granulomatous lymphadenopathy in patients with Whipple's disease. Localization of the Whipple bacillus to noncaseating granulomas by electron microscopy.

The diagnosis of Whipple's disease in a 58-year-old man was based on the finding of periodic acid-Schiff (PAS)-positive foamy macrophages on duodenal biopsy and demonstration of the typical bacilliform bodies by electron microscopy. The patient also had generalized peripheral lymphadenopathy with lymph node biopsy showing PAS-negative noncaseating granulomas. Electron microscopic examination of the lymph node specimen demonstrated a small number of typical bacilliform bodies with localization specifically to the granulomas in the lymph node. This finding of bacilliform bodies within PAS-negative noncaseating granulomas has not been reported previously. Localization of the Whipple bacillus specifically to noncaseating granulomas suggests that some patients with the disease may manifest a delayed hypersensitivity reaction to the bacillus.

Pulmonary venous infarction.

Pulmonary venous infarction, although rare, can develop in patients with the various pathologic conditions outlined. The triad of cough, dyspnea, and hemoptysis should raise clinical suspicion. The venous phase of pulmonary arteriography is the best way to document pulmonary venous obstruction, although MR imaging may also prove useful in the future. Treatment of patients with pulmonary venous infarction should be determined on the basis of the obstructing pathologic findings. Antibiotic therapy is important, as evidenced by the early experimental experience with this condition. It may be the only treatment available to patients with idiopathic fibrosing mediastinitis. Pulmonary resection, however, can be accomplished when a localized obstructing lesion is identified.

Pulmonary venous infarction secondary to squamous cell carcinoma.

This type of pulmonary venous infarction has not been previously reported, namely: pulmonary vein obstruction from squamous cell carcinoma. Furthermore, this case is unique in that the characteristic pathologic vascular changes observed with pulmonary venous infarction were contrasted with a noninfarcted upper lobe that was removed from the same patient one year later.

Cytologic diagnosis of measles pneumonia in a bronchoalveolar lavage specimen. A case report.

An immunocompromised employee of our medical center contracted measles during an epidemic and subsequently died of giant cell pneumonia. In this report we discuss the cytologic diagnosis of measles pneumonia and the differential diagnosis of multinucleate giant cells in lung cytology specimens. In the appropriate clinical setting, inclusion-bearing syncytial epithelial giant cells in lung are virtually pathognomonic of measles infection. Cytologic specimens can provide an important early diagnosis.