{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T14:08:50Z","timestamp":1785247730017,"version":"3.55.0"},"reference-count":8,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,7,7]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:p>Pulmonary alveolar proteinosis (PAP) is a rare condition characterised by impaired alveolar macrophage-mediated surfactant clearance, resulting in the accumulation of lipoproteinaceous material within the alveoli. Secondary PAP has been associated with certain medications. Ruxolitinib, a Janus kinase 1\/2 inhibitor has recently been implicated in rare cases of PAP.<\/jats:p>\n                  <jats:p>We report the case of a woman in her early 60s treated with ruxolitinib for chronic pulmonary graft-versus-host disease following an allogeneic haematopoietic stem cell transplant for acute lymphoblastic leukaemia, who developed progressive exertional dyspnoea. High-resolution CT demonstrated a \u2018crazy paving\u2019 pattern, and bronchoalveolar lavage revealed periodic acid-Schiff positive granular material consistent with PAP. Microbiological studies were negative. Ruxolitinib was discontinued with subsequent symptomatic, radiological and lung function improvement.<\/jats:p>\n                  <jats:p>This case highlights ruxolitinib as a potential cause of secondary PAP and emphasises the importance of considering this rare complication in patients who develop new respiratory symptoms while receiving ruxolitinib.<\/jats:p>","DOI":"10.1136\/bcr-2026-275429","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T13:30:11Z","timestamp":1785245411000},"page":"e275429","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Pulmonary alveolar proteinosis associated with ruxolitinib"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2465-6704","authenticated-orcid":false,"given":"Rav","family":"Sellahewa","sequence":"first","affiliation":[{"name":"Department of Respiratory Medicine and Sleep Disorders, The Royal Melbourne Hospital, Melbourne, Victoria, Australia"},{"name":"Department of Internal Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine and Sleep Disorders, The Royal Melbourne Hospital, Melbourne, Victoria, Australia"},{"name":"Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maraed","family":"Rosa","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine and Sleep Disorders, The Royal Melbourne Hospital, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renee","family":"Manser","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine and Sleep Disorders, The Royal Melbourne Hospital, Melbourne, Victoria, Australia"},{"name":"Department of Internal Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alistair","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine and Sleep Disorders, The Royal Melbourne Hospital, Melbourne, Victoria, Australia"},{"name":"Department of Internal Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6783-2301","authenticated-orcid":false,"given":"Jeff","family":"Szer","sequence":"additional","affiliation":[{"name":"Department of Clinical Haematology, The Royal Melbourne Hospital, Parkville, Victoria, Australia"},{"name":"Department of Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Qian","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine and Sleep Disorders, The Royal Melbourne Hospital, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"key":"2026072806300518000_19.7.e275429.1","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1038\/s41572-019-0066-3","article-title":"Pulmonary alveolar proteinosis","volume":"5","author":"Trapnell","year":"2019","journal-title":"Nat Rev Dis Primers"},{"key":"2026072806300518000_19.7.e275429.2","doi-asserted-by":"crossref","DOI":"10.3389\/fonc.2019.01186","article-title":"Mechanisms Underlying the Anti-inflammatory and Immunosuppressive Activity of Ruxolitinib","volume":"9","author":"Elli","year":"2019","journal-title":"Front Oncol"},{"key":"2026072806300518000_19.7.e275429.3","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.01960-2017","article-title":"Pulmonary alveolar proteinosis and Mycobacterium abscessus lung infection related to ruxolitinib after allogeneic stem cell transplantation","volume":"51","author":"Salvator","year":"2018","journal-title":"Eur Respir J"},{"key":"2026072806300518000_19.7.e275429.4","article-title":"Unusual cause of dyspnea in patient with Myelofibrosis: The Ruxolitinib lung","volume":"51","author":"El Kik","year":"2024","journal-title":"Respir Med Case Rep"},{"key":"2026072806300518000_19.7.e275429.5","doi-asserted-by":"crossref","first-page":"2023","DOI":"10.2169\/internalmedicine.4082-19","article-title":"Secondary Pulmonary Alveolar Proteinosis Associated with Primary Myelofibrosis and Ruxolitinib Treatment: An Autopsy Case","volume":"59","author":"Sugiura","year":"2020","journal-title":"Intern Med"},{"key":"2026072806300518000_19.7.e275429.6","doi-asserted-by":"crossref","first-page":"A4815","DOI":"10.1016\/j.chest.2023.07.3119","article-title":"ASSOCIATION OF RUXOLITINIB WITH PULMONARY ALVEOLAR PROTEINOSIS: A CASE REPORT","volume":"164","author":"Sharma","year":"2023","journal-title":"Chest"},{"key":"2026072806300518000_19.7.e275429.7","doi-asserted-by":"crossref","first-page":"1783","DOI":"10.1016\/j.chest.2021.05.056","article-title":"Pulmonary Alveolar Proteinosis After Allogeneic Hematopoietic Stem-Cell Transplantation in Adults: A French Soci\u00e9t\u00e9 Francophone de Greffe de Moelle et Th\u00e9rapie Cellulaire Survey","volume":"160","author":"Salvator","year":"2021","journal-title":"Chest"},{"key":"2026072806300518000_19.7.e275429.8","doi-asserted-by":"crossref","first-page":"1480","DOI":"10.1038\/bmt.2010.321","article-title":"Pulmonary alveolar proteinosis following allogeneic hematopoietic cell transplantation","volume":"46","author":"Pidala","year":"2011","journal-title":"Bone Marrow Transplant"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-275429","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T13:30:12Z","timestamp":1785245412000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-275429"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":8,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,28]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/bcr-2026-275429"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-275429","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}