case_images: PMC10512180_01
case_images: Chest CT and bronchoscopy manifestations, inflammatory indicators and pathogen detection results. (A), 3 days before admission, chest CT. (B), Day 2, bronchoscopy. (C-G), Day 5, 14, 21, 36, 57, chest CT. (H), 6 months after discharge, chest CT. (I), Variation of inflammatory indicators (CRP and PCT) (above horizontal axis). Results of pathogen detections (bellow horizontal axis). BALF and blood were collected on Day 2, 7 and 14; only blood was collected on Day 21 and 32, which were all sent for DNA mNGS and culture. Throat swab was sent for PCR testing for Influenza A virus. CRP, C-reactive protein, normal range, <5.00 mg/L. PCT, procalcitonin, normal range, <0.046 ng/mL. BALF, bronchoalveolar lavage fluid.
case_images: fcimb-13-1230813-g001.jpg
case_images: PMC10512180_01_fcimb-13-1230813-g001.jpg
case_images: f1
case_images: Chest CT showed consolidation in the middle lobe of the right lung and nodular shadows in the lower lobes of both lungs ( Figure 1A ). A large amount of pseudomembranous necrosis was seen in the airway ( Figure 1B ), and then paired bronchoalveolar lavage fluid (BALF) and peripheral blood were sent for culture and mNGS. On Day 5, chest CT indicated right pneumothorax ( Figure 1C ), so closed thoracic drainage was performed, which successfully drained yellow pus. However, Acinetobacter baumannii and Pseudomonas aeruginosa were newly cultured in BALF culture, and the CRP and PCT levels increased ( Figure 1I ). The inflammatory markers decreased ( Figure 1I ), the pulmonary inflammation alleviated ( Figures 1C-G ) and the symptoms improved. After 6 months, a repeat chest CT showed that the exudation was absorbed completely and the inflammation resolved well, with only a small amount of bronchiectasis remaining ( Figure 1H ).