Mixed Pneumonia with Pulmonary Embolism and Multiple Pathogens Detected in Bronchoalveolar Lavage Fluid: A Case Report.
Xia Chen
✦ AI-curated · Sources linked
Case in brief
A 72-year-old man presented with fever, nonproductive cough, vomiting, hypoxemia, elevated inflammatory markers, and an elevated D-dimer. Chest CT showed left lower-lobe consolidation with pleural effusion; pulmonary angiography identified a right upper-lobe pulmonary arterial filling defect. After antimicrobial therapy, bronchoalveolar lavage fluid testing by multiplex pathogen-targeted sequencing detected Chlamydia psittaci, influenza A H3N2, and Streptococcus pneumoniae, alongside other organisms. The principal detections were assessed with clinical, imaging, cytological, conventional testing, and treatment-response findings. He improved with antimicrobial and anticoagulant treatment and was discharged; rivaroxaban was continued for approximately one further month after outpatient follow-up.
What made this case unusual
The case combined pneumonia with pulmonary embolism and multiple pathogen detections in lavage fluid after antimicrobial treatment. Sequencing also identified organisms considered conditionally pathogenic or commensal, requiring interpretation alongside other clinical and laboratory findings.
Diagnostic / clinical pearl
Targeted sequencing of lavage fluid can add diagnostic information in treated pneumonia, but multiple detections should be interpreted in clinical context rather than assumed to represent active infection.