Severe alveolar proteinosis following chemotherapy for acute myeloid leukemia in a lung allograft recipient

A 64-year-old man was diagnosed with acute myeloid leukemia (AML) 5 years f ollowing single lung transplantation performed for severe pulmonary hyperte nsion from scleroderma. Chemotherapy for treatment of AML with fludarabine, cytosine arabinoside, G-CSF (FLAG) regimen was initiated. Despite intensiv e antibiotic treatment for a presumptive diagnosis of bacterial pneumonia, the patient developed acute respiratory failure and died before a complete cycle of chemotherapy could be administered. At autopsy, both native and al lograft lungs showed widespread alveolar proteinosis that was determined as the main cause of acute respiratory failure. Alveolar proteinosis, a poten tially treatable disease, should be considered in the radiologic differenti al diagnosis of diffuse lung disease in this clinical setting.