Pulmonary alveolar proteinosis (PAP) is a rare cause of chronic interstitial lung disease, characterised by accumulation of pulmonary
surfactant, respiratory insufficiency and an increased incidence of infections. The current standard therapy is whole-lung lavage to remove
the accumulated surfactant. We report on a cachexic 12-year-old boy from an informal settlement in South Africa, presenting for the first
time with PAP. Twelve litres of broncho-alveolar lavage fluid were drained under extracorporeal membrane oxygenation, and the patient
gained 10 kg during his 2-month admission.