Pulmonary alveolar microlithiasis with involvement of the sympathetic nervous system and gonads.

Pulmonary alveolar microlithiasis is a relatively rare disease, of obscure aetiology, manifested by the presence of intra-alveolar laminated concretions distributed diffusely throughout the lungs. In all the recorded cases disease has been limited to the lungs and similar lesions have not been observed in other organs or tissues. The findings in a patient in whom lesions identical to those in the lungs were confirmed in the lumbar sympathetic chain and suspected to be present in the testes are recorded. The patient, an African man aged 24 years from the Griqualand East area of South Africa, came under medical care in October 1963 when he presented with an attack of acute abdominal pain. No diagnosis was made. He had a similar attack three months later. Examination was largely negative. Radiographs of the pelvis showed scattered lines of calcification, not characteristic of that occurring in bilharzial involvement of the bladder. Laparotomy revealed no gross abnormalities. Because the possibility of a recurring pancreatitis could not be excluded, a sphincterotomy was performed. He was seen by the author four months later, during an attack of abdominal pain associated with diarrhoea , vomiting, and urinary difficulty. He responded slowly to conservative treatment and it was decided to undertake further special examinations in an attempt to establish a diagnosis. Special interrogation revealed that the patient had three brothers and three sisters. One sister had died at 23 years of age of a lung disease, but no details were available. Two brothers were available for medical examination: they were both in good health and chest radiographs were normal. There was no history of taking snuff or chewing tobacco. He smoked and drank beer in moderation. There was no opportunity for close contact with bats. The patient appeared thin but was otherwise in good physical condition. There were no significant findings on general examination apart from slight hyperextensibility of the finger joints. Clinical examination of the respiratory, cardiovascular, and nervous systems revealed no abnormalities. The abdomen showed normal findings on examination. The chest radiograph showed miliary opacities scattered throughout both lungs (Fig. 1). Repeated sputum examinations were negative for tuberculosis and showed no malignant cells. An intravenous pyelo-gram showed normal renal excretion and anatomy and a normal cystogram with good bladder evacuation. The urine was normal on chemical and microscopic examination. The linear opacities previously noted were seen in the pelvis, and a linear opacity could also be …