The n e w e ng l a n d j o u r na l of m e dic i n e

Images in Clinical Medicine

Chana A. Sacks, M.D., Editor

Pulmonary Alveolar Microlithiasis

Complicated by Tuberculosis
A B C

Gunar Günther, M.D.
Chalese Einbeck, M.D.
Katutura State Hospital
Windhoek, Namibia
gunar.guenther@insel.ch
A
36-year-old woman presented to the outpatient clinic with a
2-month history of fever, night sweats, cough, and worsening shortness of
breath. On examination, her oxygen saturation was 88% while she was
breathing ambient air. A chest radiograph showed widespread fine micronodular
opacities with a “sandstorm” appearance (Panel A). Computed tomography of the
chest revealed calcified micronodules, ground-glass opacities, and a cavitation
(Panel B). A sputum smear was negative for acid-fast bacilli. Subsequently, a trans-
bronchial biopsy was performed, and pathological examination of the tissue re-
vealed microliths (Panel C, arrow). The bronchial aspirate was positive for Myco-
bacterium tuberculosis. Testing for human immunodeficiency virus antibodies was
negative. A diagnosis of pulmonary alveolar microlithiasis complicated by tuber-
culosis was made. The patient began treatment for tuberculosis. Four weeks later,
the fever, night sweats, and cough had abated, but her shortness of breath per-
sisted. Lung transplantation — the only established treatment for pulmonary
alveolar microlithiasis — was not an available intervention in this case owing to
resource constraints.
DOI: 10.1056/NEJMicm2028047
Copyright © 2021 Massachusetts Medical Society.

e36 n engl j med 384;10 nejm.org March 11, 2021

The New England Journal of Medicine

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