Granulocyte Macrophage Colony-Stimulating Factor and whole lung lavage for pulmonary alveolar proteinosis: A synergistic effect?

Both whole lung lavage (WLL) and inhaled granulocyte macrophage colony-stimulating factor (GM-CSF) have been shown to improve patient outcomes in pulmonary alveolar proteinosis (PAP). We report a case of autoimmune PAP that was refractory to bilateral WLL, relapsing rapidly after each of her 6 treatments. A systemic GM-CSF trial was also ineffective. Her seventh WLL was followed immediately by inhaled GM-CSF, and the patient experienced a complete and sustained remission. Our case suggests that those 2 treatments might have a synergistic effect.