Three cases of pulmonary tuberculosis misdiagnosed as pulmonary alveolar proteinosis_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

CHEN Lulu ,  ZHANG Yingwei , ZHAO Qi , LIU Yin , LI Hui , DING Jingjing , CAI Hourong , XIAO Yonglong

Department of respiratory medicine, The Affiliated Drum Tower Hospital of Nanjing University, Nanjing, Jiangsu 210008, P. R. China;

Corresponding?author：

ZHANG Yingwei, Email: yingwei16@aliyun.com

Keywords：

Tuberculosis; misdiagnosis; alveolar proteinosis; crazy-paving pattern

DOI：

10.7507/1671-6205.201902028

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Objective Three cases of pulmonary tuberculosis misdiagnosed as pulmonary alveolar proteinosis were reported and analyzed in combination with literatures, so as to improve the ability of differential diagnosis of these two diseases. Methods The clinical data of 3 cases of pulmonary tuberculosis patients which were diagnosed by pathology whose imaging manifestations were similar to those of pulmonary alveolar proteinosis were collected and reviewed in combination with relevant literature. Results All the 3 patients were male, with a chronic course , no typical clinical manifestations of pulmonary tuberculosis, CT imaging showed diffuse glass grinding shadow, thickened pulmonary lobular septa ,showed "Crazy-paving pattern". ALL the three patients were considered as " pulmonary alveolar proteinosis" initially, and finally confirmed by lung biopsy or acid-resistant bacilli found by bronchoalveolar lavage. Reviewing 8 literature reports with similar imaging findings, 1 case was misdiagnosed as pulmonary alveolar proteinosis, 3 cases were pulmonary alveolar proteinosis combined with pulmonary tuberculosis, and 4 cases were secondary pulmonary alveolar proteinosis. It was found that most patients had systemic or respiratory symptoms of pulmonary tuberculosis. CT images mainly showed diffuse ground glass shadows in bilateral lungs with thickening of lobular septa, and 3 patients also showed clustered small nodulars. Most patients improved after anti-tuberculosis treatment, with only one patient dying. Conclusions The imaging manifestations of atypical pulmonary tuberculosis are various, which are easy to be misdiagnosed when they are similar to " pulmonary alveolar proteinosis". Clinicians should raise their awareness of tuberculosis with this imaging characteristic.

Citation： CHEN Lulu, ZHANG Yingwei, ZHAO Qi, LIU Yin, LI Hui, DING Jingjing, CAI Hourong, XIAO Yonglong. Three cases of pulmonary tuberculosis misdiagnosed as pulmonary alveolar proteinosis. Chinese Journal of Respiratory and Critical Care Medicine, 2023, 22(8): 578-582. doi: 10.7507/1671-6205.201902028 Copy

1.	張英為, 莊誼, 代靜泓, 等. 粟粒型肺結核誤診為過敏性肺炎原因分析. 臨床誤診誤治, 2013, 2(26): 27-29.
2.	葛挺, 吳宏成. 雙肺彌漫病變伴高熱的不典型肺結核一例報告. 現代實用醫學, 2011, 23(1): 113-114.
3.	Tekgül S, Bilaceroglu S, Ozkaya S, et al. Pulmonary alveolar proteinosis and superinfection with pulmonary tuberculosis in a case. Respir Med Case Rep, 2012, 5: 25-28.
4.	Cheraghvandi A, Fallah Tafti S, Talischi F, et al. Silicoproteino-tuberculosis: three distinct entities or a unique entity: a case report and review of the literature. Med J Islam Repub Iran, 2014, 28(1): 23.
5.	Bai H, Meng ZR, Ying BW, et al. Pulmonary alveolar proteinosis complicated with tuberculosis: A case report. World J Clin Cases, 2021, 9(17): 4400-4407.
6.	Zhang DM, Tian XL, Feng RE, et al. Secondary pulmonary alveolar proteinosis: a single-center retrospective study (a case series and literature review). BMC Pulm Med, 2018, 18(1): 15.
7.	陳露露, 張艷秋, 邱玉英, 等. 肺泡蛋白沉積癥106例臨床分析. 南京醫科大學學報(自然科學版), 2018, 6(38): 804-806.
8.	Feng YK, Zhao JP, Yang Q, et al. Pulmonary melanoma and “crazy paving” patterns in chest images: a case report and literature review. BMC Cancer, 2016, 16: 592.
9.	Rossi SE, Erasmus JJ, Volpacchio M, et al. "Crazy-paving" pattern at thin-section CT of the lungs: radiologic-pathologic overview. Radiographics, 2003, 23(6): 1509-1519.
10.	宋超, 羅百靈, 龔麗, 等. 7例影像學表現為彌漫肺間質性病變的肺結核報道及文獻復習. 現代生物醫學進展, 2017, 17(8): 1513-1516.
11.	Zhan X, Wang Z, Zhang L, et al. Clinical and pathological features of adult pulmonary tuberculosis with reversed halo sign. Int J Tuberc Lung Dis, 2013, 17(12): 1621-1625.
12.	曾曉媛, 楊紅忠, 彭毅強. 以肺間質性改變為影像學表現的肺結核4例報道. 臨床肺科雜志, 2014, 19(11): 2105-2107.

1. 張英為, 莊誼, 代靜泓, 等. 粟粒型肺結核誤診為過敏性肺炎原因分析. 臨床誤診誤治, 2013, 2(26): 27-29.
2. 葛挺, 吳宏成. 雙肺彌漫病變伴高熱的不典型肺結核一例報告. 現代實用醫學, 2011, 23(1): 113-114.
3. Tekgül S, Bilaceroglu S, Ozkaya S, et al. Pulmonary alveolar proteinosis and superinfection with pulmonary tuberculosis in a case. Respir Med Case Rep, 2012, 5: 25-28.
4. Cheraghvandi A, Fallah Tafti S, Talischi F, et al. Silicoproteino-tuberculosis: three distinct entities or a unique entity: a case report and review of the literature. Med J Islam Repub Iran, 2014, 28(1): 23.
5. Bai H, Meng ZR, Ying BW, et al. Pulmonary alveolar proteinosis complicated with tuberculosis: A case report. World J Clin Cases, 2021, 9(17): 4400-4407.
6. Zhang DM, Tian XL, Feng RE, et al. Secondary pulmonary alveolar proteinosis: a single-center retrospective study (a case series and literature review). BMC Pulm Med, 2018, 18(1): 15.
7. 陳露露, 張艷秋, 邱玉英, 等. 肺泡蛋白沉積癥106例臨床分析. 南京醫科大學學報(自然科學版), 2018, 6(38): 804-806.
8. Feng YK, Zhao JP, Yang Q, et al. Pulmonary melanoma and “crazy paving” patterns in chest images: a case report and literature review. BMC Cancer, 2016, 16: 592.
9. Rossi SE, Erasmus JJ, Volpacchio M, et al. "Crazy-paving" pattern at thin-section CT of the lungs: radiologic-pathologic overview. Radiographics, 2003, 23(6): 1509-1519.
10. 宋超, 羅百靈, 龔麗, 等. 7例影像學表現為彌漫肺間質性病變的肺結核報道及文獻復習. 現代生物醫學進展, 2017, 17(8): 1513-1516.
11. Zhan X, Wang Z, Zhang L, et al. Clinical and pathological features of adult pulmonary tuberculosis with reversed halo sign. Int J Tuberc Lung Dis, 2013, 17(12): 1621-1625.
12. 曾曉媛, 楊紅忠, 彭毅強. 以肺間質性改變為影像學表現的肺結核4例報道. 臨床肺科雜志, 2014, 19(11): 2105-2107.

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Three cases of pulmonary tuberculosis misdiagnosed as pulmonary alveolar proteinosis

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