A case of PAP and Nocardia spp. brain abscess is described. A comprehensive review of the English-language literature was conducted to identify all reported cases of PAP and opportunistic infections between 1950 and July, 2010.
Seventy five cases were reviewed. Thirty two patients (43 % ) had nocardial infection, 28 (37 % ) mycobacterial infection, and 15 (20 % ) fungal infection. Thirty nine patients (65 % ) were male. Seventeen patients (23 % ) were immunosuppressed. Twenty patients (27 % ) were active smokers. PAP was the initial diagnosis in 19 patients (33 % ), while infection presented first in 23 patients (40 % ); 16 patients (27 % ) had a concurrent diagnosis of PAP and infection. The average interval between PAP diagnosis and an opportunistic infection was 16 months. Lungs were the most common site of infection; extra-pulmonary infection was present in 27 patients (32 % ). Thirty nine patients (57 % ) survived through the follow-up period, while 31 died.
Opportunistic infections can either precede or follow a diagnosis of PAP. PAP should be considered in apparently immunocompetent patients who present with an opportunistic infection and diffuse alveolar infiltrates.