{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T02:48:12Z","timestamp":1782442092567,"version":"3.54.5"},"reference-count":5,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Respirology Case Reports"],"published-print":{"date-parts":[[2026,6]]},"abstract":"ABSTRACT<\/jats:title>\n \n Pulmonary alveolar proteinosis (PAP) is a rare granulocyte\u2013macrophage colony\u2010stimulating factor (GM\u2010CSF) dependent lung disease treated primarily with whole\u2010lung lavage (WLL); recurrence after lung transplantation is uncommon and poorly characterised. We present a 73\u2010year\u2010old Hispanic man with PAP who developed recurrent disease more than 3\u2009years after bilateral lung transplantation. High\u2010resolution CT showed evolving ground\u2010glass opacities and crazy\u2010paving, and anti\u2013GM\u2010CSF antibodies were positive, yet repeated bronchoalveolar lavage and transbronchial biopsies were initially PAS\u2010negative. Concomitant\n \n Mycobacterium avium<\/jats:italic>\n <\/jats:styled-content>\n complex, Aspergillus and Nocardia infections mimicked recurrent PAP and coincided with an atypical shift in spirometry from supranormal airflow (FEV\n 1<\/jats:sub>\n 110% predicted; FEV\n 1<\/jats:sub>\n \/FVC 91%) to obstruction (FEV\n 1<\/jats:sub>\n 99% predicted; FEV\n 1<\/jats:sub>\n \/FVC 68%). Ultimately, repeat lavage revealed PAS\u2010positive lipoproteinaceous material, and treatment with inhaled sargramostim plus two sequential WLLs produced marked radiographic clearance, symptomatic relief and partial spirometric recovery. Our case highlights how multimodal, longitudinal clinical surveillance remains essential in lung transplant recipients.\n <\/jats:p>","DOI":"10.1002\/rcr2.70653","type":"journal-article","created":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T03:15:42Z","timestamp":1781320542000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic and Therapeutic Dilemmas in Recurrent Pulmonary Alveolar Proteinosis After Bilateral Lung Transplantation"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-1602-6882","authenticated-orcid":false,"given":"Omar","family":"Lopez","sequence":"first","affiliation":[{"name":"Section of General Internal Medicine University of Chicago Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2665-9931","authenticated-orcid":false,"given":"Deven","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Pathology University of Chicago Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shreya","family":"Podder","sequence":"additional","affiliation":[{"name":"Section of Pulmonary and Critical Care University of Chicago Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajay","family":"Wagh","sequence":"additional","affiliation":[{"name":"Section of Pulmonary and Critical Care University of Chicago Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms25137092"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/resp.13831"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213\u20102600(18)30043\u20102"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100033\u20101348472"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2025.108167"}],"container-title":["Respirology Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/rcr2.70653","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/rcr2.70653","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/rcr2.70653","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T02:41:27Z","timestamp":1782441687000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/rcr2.70653"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":5,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1002\/rcr2.70653"],"URL":"https:\/\/doi.org\/10.1002\/rcr2.70653","archive":["Portico"],"relation":{},"ISSN":["2051-3380","2051-3380"],"issn-type":[{"value":"2051-3380","type":"print"},{"value":"2051-3380","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]},"assertion":[{"value":"2026-03-31","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70653"}}