First successful whole lung lavage for pulmonary alveolar proteinosis in Mongolia: A Case Report

Amartuvshin G; Altanzul L; Ichinnorov D; Naidansuren Ts; Solongo B; Densenbal D; Tumen-Ulzii G; Allabyergyen M; Tumurjin G; Khaliun P; Tamir L; Erdenetuya E; Byambasuren S; Ankhzaya B; Ganbold L; Manaljav Ts

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First successful whole lung lavage for pulmonary alveolar proteinosis in Mongolia: A Case Report

VernacularTitle:Цулцангийн протеинозийн үед уушги бүтэн угаах эмчилгээг Монгол Улсад анх удаа нэвтрүүлсэн тохиолдол
Author: Amartuvshin G ¹ ; ² ; Altanzul L ³ ; Ichinnorov D ¹ ; ² ; Naidansuren Ts ¹ ; Solongo B ¹ ; Densenbal D ¹ ; ² ; Tumen-Ulzii G ¹ ; ² ; Allabyergyen M ² ; Tumurjin G ² ; Khaliun P ² ; Tamir L ⁴ ; Erdenetuya E ⁴ ; Byambasuren S ³ ; Ankhzaya B ³ ; Ganbold L ³ ; Manaljav Ts ¹ ; ²
Author Information

1. Department of Pulmonology and Allergology, School of Medicine, MNUMS
2. Inpatient Department-1, Mongolia-Japan Hospital, MNUMS
3. Joint Department of Anesthesiology and Surgery, Mongolia-Japan Hospital, MNUMS
4. Intensive Care Unit, Mongolia-Japan Hospital, MNUMS
Publication Type:Case Reports
Keywords: Respiratory failure; GM-CSF; bronchoscopy; surfactant accumulation
From: Mongolian Journal of Health Sciences 2026;93(3):212-216
CountryMongolia
Language:Mongolian
Abstract: Background:Pulmonary alveolar proteinosis (PAP) is a rare lung disorder characterized by the accumulation of surfactant within the alveoli, leading to impaired gas exchange and respiratory insufficiency. Although the disease is uncommon, it significantly affects patients’ quality of life and requires specific diagnostic and therapeutic approaches. Whole lung lavage (WLL) is considered the standard treatment; however, it has not been widely implemented in Mongolia. We report the first successful case of WLL performed for PAP in Mongolia.
Case Presentation:A 56-year-old male presented with dyspnea. Chest computed tomography demonstrated a bilateral “crazy paving” pattern. Bronchoalveolar lavage fluid was positive for periodic acid–Schiff (PAS) staining, and anti–GM-CSF antibodies were detected, confirming the diagnosis of PAP. WLL was performed under general anesthesia using a double-lumen endotracheal tube with bronchoscopic guidance. One lung was ventilated with 100% oxygen while the contralateral lung was sequentially lavaged with 800–1000 mL of warm (37°C) saline per cycle until the effluent became clear. A total of approximately 20 liters of saline was used.
Result:The procedure was completed successfully without complications. Following treatment, the patient showed marked clinical improvement with reduced dyspnea and increased exercise tolerance. Oxygen saturation improved from 88% to 93%, and spirometric parameters (FVC, FEV₁) demonstrated improvement. Chest imaging revealed a reduction in pulmonary opacities.
Conclusion:This case demonstrates the successful implementation of whole lung lavage (WLL) in Mongolia and highlights its importance in improving the diagnostic and therapeutic capacity for rare pulmonary diseases such as pulmonary alveolar proteinosis. The procedure resulted in significant improvement in clinical, functional, and radiological parameters, consistent with findings from international studies. Early diagnosis of PAP and the adoption of standardized protocols in accordance with international guidelines are essential to optimize treatment outcomes and enhance patients’ quality of life.
Full text:202609271000075605728_212-216_Цулцангийн протеинозийн үед уушги бүтэн угаах эмчилгээг Монгол Улсад анх удаа нэвтрүүлсэн тохиолдол.pdf