PMC9226341_01
Chest computed tomography images at admission. A consolidation shadow in the right upper and middle lobes, with necrosis containing foci of air. (A,C) lung window; (B,D) mediastinal window.
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F1
A chest computed tomography (CT) scan showed a consolidation shadow in the upper and middle lobes of right lung with foci of necrosis (Figure 1).
A series of bronchoscopy images. The first bronchoscopy images (A-C), the secondary bronchoscopy images (D-F). (A) The medial and lateral segments of the RML were blocked by purulent yellow secretions. (B) The medial subsegment of the RML was completely obstructed by an endobronchial white necrotized mass. (C) The media subsegment of the RML became unobstructed after suction. (D) The medial and lateral segments of the RML were blocked by purulent yellow secretions. (E) The medial subsegment of the RML was completely obstructed by a an endobronchial white necrotized mass. (F) The media subsegment of the RML became unobstructed after suction. RML: Right middle lobe.
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To make a definitive diagnosis, we performed a flexible bronchoscopy (Figures 2A-C), revealing purulent secretions in the medial and lateral segments of the right middle lobe (RML), drastically obstructing the lumen. To reduce secretions and search pathogens, we performed a second flexible bronchoscopy (Figures 2D-F), showing purulent secretions in the medial segment of the RML and the anterior segment of the right upper lobe (RUL).
Gram stain of the bronchoalveolar lavage fluid.
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We took an appropriate amount of BALF samples for Gram staining, which is blue-purple (Figure 3).
Serial changes on chest computed tomography findings. Chest CT at discharge (A-D). Chest CT at one month's follow-up (E-H). Chest CT at three months' follow-up (I-L). Chest CT at five months' follow-up (M-P). Chest CT at seven months' follow-up (Q-T). CT: computed tomography.
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A. graevenitzii. After administration of antibiotic treatment with piperacillin-sulbactam for ten days, the clinical condition of the patient improved obviously, and the CRP dropped to 29.34 mg/L, though the pulmonary lesions on the chest CT scan (Figures 4A-D) were not significantly absorbed. At the 7-month follow-up, the clinical condition of the patient was getting better and the chest CT scans (Figure 4) revealed that the consolidation shadow of the right lung was gradually absorbed.
Timeline with the most relevant data of the clinical case.
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F5
A timeline with all relevant data from this clinical case is available in Figure 5.