Subcutaneous injections or inhalations of GM-CSF, which have been successfully utilized in adult patients with autoimmune PAP [22, 23] , were not helpful in our case to reduce alveolar filling as assessed by CT scanning (not shown) or improvement in gas exchange ( Figure 2 ). Treatment with 20 μg/kg of GM-CSF per day subcutaneously was also shown to be ineffective for the child with congenital PAP described by Martinez-Moczygemba et al. [7] .