Acute Hypoxemic Respiratory Failure Secondary to Recurrent Pulmonary Alveolar Proteinosis: A Case Report

Pulmonary alveolar proteinosis (PAP) is a rare interstitial disease characterized by accumulation of surfactant lipoproteinaceous material in pulmonary alveoli. PAP presents with varying symptomatology but commonly develops progressive respiratory insufficiency from poor oxygenation. We report a 47-year-old man with recurrent PAP who presented with acute-on-chronic hypoxemic respiratory failure. He was hospitalized for respiratory failure with oxygen saturation of 78%. Chest CT showed a “crazy-paving” pattern. Bronchoscopy revealed diffuse milky secretions, leading to a diagnosis of PAP. He improved after therapeutic whole-lung lavage. This case emphasizes PAP’s relapsing nature, the diagnostic benefit of bronchoalveolar lavage, and the need for long-term follow-up by specialists.