PMC5784280_01
(a) X-ray chest showing patchy opacity on the left midzone and right paracardiac region (pneumonitis) along with left hilar and right basal infection (alveolar proteinosis). (b and c) contrast-enhanced computed tomography chest showing bilateral ground-glass haze in lung parenchyma with interlobular septal thickening along with characteristic crazy pavement was noted on contrast-enhanced computed tomography chest suggesting a possibility of alveolar proteinosis
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F1
An impression of pneumonitis and alveolar proteinosis was given based on X-ray findings [Figure 1a]. The characteristic crazy pavement was noted on CECT chest [Figure 1b and c].
(a and b) Photomicrograph showing plaques of eosinophilic material and few groups of macrophages filled with the similar eosinophilic material. (a and b) Papanicolaou x20 and x40). Inset ([a] Few benign endobronchial cells). (c) Smear revealing few plaques of eosinophilic material and background showing inflammatory cells (Giemsa, x40). (d) Eosinophilic globules showing periodic acid-Schiff positivity (x40)
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F2
Smears examined showed plaques of eosinophilic material and few groups of macrophages filled with the similar eosinophilic material [Figure 2a-c]. These plaques were positive for PAS [Figure 2d]. Smears also revealed acute and chronic inflammatory cells with marked eosinophilia along with few singly scattered respiratory epithelial cells [Figure 2a, inset].