Post-bronchoscopy Pneumonia in the Setting of Mycobacterium Tuberculosis Pulmonary Disease

Abstract Introduction: Diagnostic flexible bronchoscopy is a quick and safe procedure. However, on rare occasions, this may have an immediate infectious complication. We report a case of pneumonia that could have worsened post-bronchoscopy in the setting of Mycobacterium tuberculosis pulmonary disease. Case: A 67 year old male with a history of squamous cell carcinoma in the maxillary sinus s/p maxillectomy with orbital exenteration followed by radiation therapy was referred to the Pulmonary Clinic for worsening right upper lobe (RUL) consolidation for the past 6 months accompanied by significant weight loss. To rule out recurrence of malignancy, he underwent flexible bronchoscopy with radial EBUS guided biopsy of the consolidated area at the apical segment of RUL. He had no significant hilar and mediastinal adenopathy on linear EBUS surveillance. About 50cc of saline was instilled in the RUL apical segment for bronchoalveolar lavage (BAL). No other BAL was made. Immediate post-operative condition was unremarkable however within 48 hours, the patient developed fever, cough and increasing dyspnea. Chest imaging showed acute evolution of diffuse patchy opacities involving the right hemithorax. Results of BAL on bronchoscopy showed evidence of Mycobacterium tuberculosis (MTB). Biopsy had no evidence of malignancy but was noted to have necrosis with giant cells. No other bacterial growth was noted. Patient was started on anti-Tuberculosis medication (RIPE – rifampin, isoniazid, pyrazinamide and ethambutol) but the team also decided to give a short course of broad-spectrum empiric antibiotic treatment which was discontinued after MRSA screen and final BAL cultures resulted negative for concomitant bacterial growth. No steroid therapy was given. Patient's symptoms improved after 72 hours. Discussion: Bronchoscopy is a safe procedure but can sometimes be associated with complications such as pneumonia. Pulmonary infection is a relatively rare but serious complication after a procedure. In a retrospective study of 636 cases, pulmonary infection following procedure occurred in 19 cases (3%). In a larger nationwide study, pulmonary infection occurred in 0.2% of cases. Limited studies identify larger lesion size and the presence of endobronchial lesions as independent factors associated with post-bronchoscopy pulmonary infection.