• Tetsuro Ohnishi, Gen Yamada, Noriharu Shijubo, Yoko Takagi-Takahashi, Takayuki Itoh, Hiroki Takahashi, Masaaki Satoh, Hiroyuki Koba, Koh Nakata, and Shosaku Abe.
• Third Department of Internal Medicine, Sapporo Medical University School of Medicine, Sapporo.
• Intern. Med. 2003 Feb 1; 42 (2): 187-90.

AbstractA 47-year-old man, who had been diagnosed as myelodysplastic syndrome (MDS), complained of a severe cough and a high-grade fever. Chest CT disclosed scattered small nodules and ground-glass opacities with interlobular septal thickening in both lung fields and a mass lesion in the right lower lobe. Pathological findings of the ground-glass opacities and the mass lesion obtained by video-assisted thoracoscopic surgery revealed the accumulation of eosinophilic amorphous material in the alveoli and confirmed the diagnosis of pulmonary alveolar proteinosis (PAP). Autoantibodies against granulocyte-macrophage colony-stimulating factor (GM-CSF) in sera were below sensitivity, while the GM-CSF level was elevated in bronchoalveolar lavage fluid. He was diagnosed as secondary PAP associated with MDS.

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