Fig. 4

Clinical course and images after whole lung lavage. A Changes in therapeutic agents and laboratory values. Anti-MDA-5 antibody levels decreased after treatment with anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis complicated by interstitial pneumonia, but KL-6 tended to increase after 8 months. After diagnosis of APAP, prednisolone (PSL) was tapered off and whole-lung lavage was performed, after which KL-6 decreased. The anti-GM-CSF antibody titer was high from the first admission, suggesting that it remained high until the onset of APAP. B Chest radiograph and computed tomography (CT) after whole lung lavage. Significant improvement in ground-glass shadows in both lungs was found after whole lung lavage. PSL, prednisolone; TAC, tacrolimus; IVCY, intravenous cyclophosphamide; IVIg, intravenous immunoglobulin; MDA-5, melanoma differentiation-associated gene 5; GM-CSF, granulocyte–macrophage colony-stimulating factor; KL-6, Krebs von den Lungen 6; APAP, autoimmune pulmonary alveolar proteinosis