Pulmonary alveolar proteinosis in an infant.

27 patients with a newly-recognized pulmonary disease which they called pulmonary alveolar proteinosis (PAP). Since then approximately 100 cases have been reported. These are reviewed by Davidson and Macleod (1969). Only once has this condition been reported in early infancy. Wilkinson, Blanc, and Hagstrom (1968) described two babies who presented with respiratory symp-toms, and died at 41 and 3 months. The radio-graphic changes of PAP were present in both instances. We present a further case which differed in presenting with frequent pyogenic infections from the age of 2 weeks, but no clinical signs of respiratory disease until shortly before death at 3j months. Chest x-rays showed abnormalities from the age of 6 weeks, but even in retrospect these could not be considered diagnostic. Case History The patient was the only child of healthy parents. Pregnancy and delivery were normal. Birthweight was 3-8 kg. At 2 weeks of age, he developed profusely purulent, but sterile conjunctivitis. Despite therapy with neomycin-bacitracin eye ointment and oral cloxacillin, the conjunctival oedema and infection became worse and the comea became obscured. At 7 weeks he was admitted to another hospital because of the conjunctivitis. Additional findings included re-solving oral moniliasis and superficial skin sepsis. Weight gain had been normal, to 4-5 kg. Bacterial cultures were again negative, as were cytology and complement-fixation tests for herpes. The conjuncti-vitis improved on framycetin eye drops and intra-muscular ampicillin and cloxacillin, but the comeae were already scarred. As the eyes improved, diarrhoea and vomiting with concomitant weight loss developed. The chest x-ray showed consolidation of the right upper lobe. At 11 weeks he was transferred to this hospital. His weight was 3-7 kg. He had persisting conjuncti-vitis, vomiting and diarrhoea, and skin infections.