ArticleFrontiers in medicine2026
Case Report: Pulmonary alveolar proteinosis and fibrosis associated with indium-tin-oxide exposure.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Pulmonary alveolar proteinosis (PAP) is a rare respiratory disorder characterized by the excessive accumulation of surfactant material on alveolar surfaces and the dysfunction of alveolar macrophages. Indium-tin-oxide (ITO), a substance utilized in liquid crystal displays and solar panels, could be a potential cause of secondary PAP. Here, we report a rare case of interstitial lung disease in a solar panel processing worker with ITO exposure, which was pathologically confirmed as PAP and then progressed to pulmonary fibrosis. Case presentation: A 35-year-old male was admitted with a symptom of dysponea. Chest computed tomography revealed diffuse, bilateral ground-glass opacities and interlobular septal thickening in both lungs. Transbronchial lung biopsy was PAS-positive, confirming the diagnosis of PAP. The indium levels in the patient's bronchoalveolar lavage fluid and plasma were far above the normal range. He underwent whole-lung lavage, but approximately 4 months later, he still developed progressive pulmonary fibrosis. Nintedanib showed no significant effect in slowing the decline of his lung function. Conclusion: When a patient has a definite history of indium exposure, the diagnosis of PAP should be considered. Workers need to wear protective measures daily, as lung diseases caused by ITO exposure are associated with a poor prognosis.
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