Whole Pulmonary Lavage: Treating Pulmonary Alveolar Proteinosis at the Time of COVID Pandemic

Pulmonary alveolar proteinosis (PAP) is a rare syndrome due to increased production or decreased clearance of surfactant in alveoli and terminal bronchi that cause hypoxemic respiratory insufficiency. Here we present a patient with past medical history of PAP whose disease was exacerbated by superimposed COVID-19 pneumonia. He underwent whole pulmonary lavage (WPL). Evaluation of the viral count of the first and the last lavage of the left lung showed viral load in the alveolar space dropped by approximately 10-folds, however the magnitude of the viral load was substantial in both lavage samples. Whole pulmonary lavage may be used as a treatment option on patients with COVID pneumonia superimposed on a pulmonary alveolar proteinosis (PAP) exacerbation.