Pulmonary alveolar proteinosis (PAP) is a rare disease characterized by the accumulation of surfactant lipids and proteins in the alveoli of the lungs, leading to respiratory insufficiency and alveolar macrophage dysfunction. The median age at diagnosis is 42 years. It is uncommon in the elderly and has a high morbidity, mainly from respiratory failure and infection. We report the case of a 74-year-old female diabetic patient with PAP and pulmonary aspergillosis complicated by severe hypoxemic respiratory failure and long-term ventilator dependence. The hypoxemia was resolved, lung infiltrates reduced, and the patient was weaned from the ventilator after successful anti-fungal therapy and sequential unilateral whole lung lavage.
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