PMC8208758_01
CXR showing hyperinflated lungs with patchy opacities in the right lung and small cavities bilaterally.
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F1
Chest x-ray revealed hyperinflated lungs, consistent with emphysema, and with patchy reticular opacities in the middle zone of right lung (Fig. 1).
Gram stain (100X) showing Gram-negative bacilli. Growth on 5 % sheep blood agar showing rough and corrugated colonies.
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F2
Gram staining of sputum revealed many pus cells with presence of Gram-negative rods, and sputum culture grew moist, creamish colonies on sheep blood agar (Fig. 2) that were later identified as  B. cepacia  based on battery of tests suggesting motile, oxidase positive, catalase positive bacilli.
CT chest showed centriacinar emphysematous changes involving the bilateral lung parenchyma, predominantly the bilateral upper lobe parenchyma. Central tubular bronchiectasis with bronchial wall thickening is seen involving the segmental and lobar bronchi of the right middle and lower lobe, and lower lobe of the left lung parenchyma.
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F3
Computerized tomography of chest confirmed centriacinar emphysematous changes with central, tubular bronchiectasis (Fig. 3).