Correct!
5. None of the above

There are multiple treatment options available for alveolar proteinosis including (2):

1. Whole lung lavage
2. GM-CSF: systemic or inhaled
3. Rituximab (1 series of 10 patients)
4. Plasmapharesis (case reports)
5. Lung transplant (relapses reported)
6. Spontaneous remissions occur in up to 25% (no reported association with pregnancy)

None of these seemed appropriate in this situation and she was followed while on supplemental oxygen. She had a successful delivery in August, 2014 of a healthy child. She felt her breathing had improved after delivery and GM-CSF was restarted. Repeat PFTs in October, 2014 showed her FVC was 66% of predicted and her DLco 50% predicted although her chest x-ray continued to show diffuse consolidation (Figure 5).

Figure 5. Repeat chest x-ray showing diffuse consolidation.

She continued to improve and in April, 2015 her  FVC was 80% of predicted and her DLco was 70% of predicted.

References

1. Presneill JJ, Nakata K, Inoue Y, Seymour JF. Pulmonary alveolar proteinosis. Clin Chest Med. 2004;25(3):593-613. [CrossRef] [PubMed] 
2. Luisetti M, Kadija Z, Mariani F, Rodi G, Campo I, Trapnell BC. Therapy options in pulmonary alveolar proteinosis. Ther Adv Respir Dis. 2010;4(4):239-48. [CrossRef] [PubMed]

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