Pulmonary Alveolar Proteinosis and Nocardia Brain Abscess

A 33-year-old white man with previously undiagnosed and relatively asymptomatic pulmonary alveolar proteinosis had a Jacksonian seizure. The diagnosis of pulmonary alveolar proteinosis was established by open lung biopsy. A craniotomy was performed, and aNocardiabrain abscess was excised. The patient was treated with sulfonamides and recovered. The intra-alveolar phospholipid that accumulates in this disease tends to become infected by opportunistic fungi, particularlyNocardiaspecies. As many as 30% of cases of nocardiosis may show cerebral involvement.