Lipoproteinosis alveolar tratada con lavado broncopulmonar

Montero, M.C.; Pombo, F.; García, E.; Vázquez, A.; Blanco, M.; Verea, H.

doi:10.1016/S0300-2896(15)30852-8

Archivos de Bronconeumología

ISSN: 0300-2896

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Vol. 31. Issue 10.

Pages 537-539 (December 1995)

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Pages 537-539 (December 1995)

DOI: 10.1016/S0300-2896(15)30852-8

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Lipoproteinosis alveolar tratada con lavado broncopulmonar

Alveolar lipoproteinosis treated with bronchopulmonary lavage

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M.C. Montero*, F. Pombo, E. García, A. Vázquez, M. Blanco, H. Verea

Servicio de Neumología. Hospital Juan Canalejo. La Coruña

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La lipoproteinosis alveolar es una enfermedad muy infrecuente. Una revisión realizada en el Index Médico Español de 1971 a junio de 1994 sólo muestra 9 casos. El depósito intraalveolar de este material lipoproteínico produce hipoxemia severa y favorece la infección por gérmenes oportunistas. El tratamiento con lavado bronquial masivo (LBM) remueve este material intraalveolar y así mejora el intercambio de gases y disminuye el riesgo de infecciones.

Aportamos un caso de lipoproteinosis alveolar primaria tratado con LBM, que previo a este tratamiento y después de iniciar tratamiento esteroide desarrolló una infección por Aspergillus fumigatus. En este paciente esta terapéutica se realizó sin complicaciones y con ella se obtuvo gran mejoría clínica y gasometría. La historia natural de esta enfermedad es poco conocida. Se han observado remisiones espontáneas y debido a que el LBM no está exento de riesgos sigue existiendo controversia sobre la indicación de este tratamiento.

Nosotros pensamos que cuando hay hipoxemia importante debe realizarse precozmente porque tiene pocos riesgos, mejora el intercambio de gases y probablemente disminuye el riesgo de infecciones oportunistas.

Palabras clave:

Lipoproteinosis alveolar

Lavado broncopulmonar

Aspergilosis

Alveolar lipoproteinosis is a rare disease, a review of the Spanish Medical Index for 1971 to June 1994 showing only 9 reported cases. The intra-alveolar deposit of lipoproteintype matter produces severe hypoxemia and favors infection by opportunistic germs. Treatment with massive bronchial lavage (MBL) removes the matter from the alveolar space, improves gas exchange and decreases the risk of infection.

We report a case of primary alveolar lipoproteinosis treated with MBL in which the patient developed infections by Aspergillus fumigatus before lavage and after starting steroid treatment. The procedure was performed without complications, with significant clinical and gasometric improvement. The natural evolution of this disease is poorly understood. Spontaneous remissions have been observed, and as MBL is not a risk-free procedures, its use in treatment is controversial. We believe that when severe hypoxemia is present, MBL should be used early, when the risk is slight; MBL improves gas exchange and probably reduces the risk of opportunistic infection.

Key words:

Alveolar lipoproteinosis

Bronchoalveolar lavage

Aspergillosis

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