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Pulmonary alveolar proteinosis — SCE Respiratory MCQ

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HardRare respiratory diseasePulmonary alveolar proteinosisSCE Respiratory

A 45-year-old man has progressive dyspnoea and cough. HRCT shows diffuse crazy-paving with interlobular septal thickening and ground-glass opacification; bronchoalveolar lavage returns opaque milky fluid that is PAS-positive. Serum anti-GM-CSF antibodies are positive. What is the most likely diagnosis?

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Correct answer: D — Autoimmune pulmonary alveolar proteinosis

The best answer is “Autoimmune pulmonary alveolar proteinosis”. The clinical pattern, physiology and imaging described are most consistent with Autoimmune pulmonary alveolar proteinosis. The competing diagnoses may share individual findings, but do not account for the complete combination in the stem. The remaining choices—“Pulmonary oedema from left heart failure”, “Acute eosinophilic pneumonia”, “Diffuse alveolar haemorrhage”, “Pneumocystis jirovecii pneumonia”—are credible in related respiratory presentations, but each addresses a different diagnostic, staging or management decision and does not fit the decisive findings and pathway position in this stem.

Reference: British Thoracic Society respiratory guidance library: https://www.brit-thoracic.org.uk/quality-improvement/guidelines/