[Nontuberculous mycobacteria infection and pulmonary alveolar proteinosis in a patient with hematopoietic defects].

A 28-year-old male with a history of leukopenia was admitted with complaints of fever, cough, and dyspnea for 3 months. Initial work-up identified reduced circulating levels of granulocytes, monocytes, lymphocytes, and NK cells. Computed tomography revealed bilateral reticulonodular opacities and mediastinal lymph node enlargement. Peripheral blood culture and mediastinal lymph node aspiration yielded Mycobacterium avium. Genetic testing revealed a heterozygous germline GATA2 mutation (c.1187G>A, R396Q). Despite standard anti-mycobacterial therapy, the patient's dyspnea worsened and subsequent imaging studies revealed diffuse ground-glass opacification. A transbronchial lung biopsy confirmed the development of pulmonary alveolar proteinosis. Bone marrow transplantation had not been performed due to the unavailability of suitable donors. The disease progressed after whole lung lavage, and the patient died at the age of 31 years from respiratory failure. The current case report emphasized the importance of raising awareness about the rare GATA2 deficiency, which is characterized by hematologic abnormalities, primary immunodeficiency, and pulmonary alveolar proteinosis.本文报道1例28岁男性患者，临床以白细胞减少、发热、咳嗽、呼吸困难起病。检查发现单核细胞、中性粒细胞、B细胞、T细胞、NK细胞计数减少及贫血，骨髓检查提示造血衰竭。胸部影像学示双肺多发斑点及小斑片影、纵隔淋巴结肿大，经外周血培养、纵隔淋巴结穿刺证实存在播散性鸟分枝杆菌感染。外周血基因检测发现GATA2 c.1187G>A（R396Q）杂合变异。抗分枝杆菌治疗后患者呼吸困难仍持续加重，影像学发现双肺范围逐渐扩大的磨玻璃影，病理证实合并肺泡蛋白沉积症。患者因无合适供者未行骨髓移植，全肺灌洗后短期内病情继续进展，最终因呼吸衰竭于起病3年后死亡。本文报道了一例由GATA2缺陷引起的原发性免疫缺陷伴血液系统异常和肺泡蛋白沉积症，以期提高临床医师对该种罕见病的认识。.