Abstract
BACKGROUND: There have been no previously reported cases of pulmonary alveolar proteinosis (PAP) complicated by invasive pneumococcal infection requiring veno-venous extracorporeal membrane oxygenation (V-V ECMO). CASE PRESENTATION: A 44-year-old man was transferred to our hospital under V-V ECMO for severe respiratory failure. Chest computed tomography showed bilateral crazy-paving patterns, and milky bronchoalveolar lavage fluid confirmed PAP. On day 3, he developed septic shock due to Streptococcus pneumoniae. After stabilization, right-sided whole lung lavage was performed on day 7, yielding yellow-brown fluid atypical for PAP. Bilateral segmental lavages on days 12 and 13 improved oxygenation. ECMO was discontinued on day 10, and the patient was extubated on day 14. CONCLUSION: In this rare case of PAP complicated by invasive pneumococcal infection, timely therapeutic interventions were successfully performed under V-V ECMO support.