Page 72 - ECBIP 2021_Program

6th European Congress ECBIP 15 - 17
Book of Abstracts
for Bronchology and
Interventional Pulmonology ATHENS - GREECE 2021
OCTOBER
MODERATED e-POSTER SESSION 06:
Infectious Diseases and COVID-19
MUCH MORE THAN AN ENDOBRONCHIAL STENT
Ricardo Quita, Diana Mano, Nuno Faria, Bruno Silva, Maria Sucena
Centro Hospitalar e Universitário do Porto, Porto, Portugal
PP43
Introduction: Endobronchial stents are tube-shaped devices introduced in the airways used in several clinical conditions, mostly related to endobronchial obstruction. These stents, however, are foreign objects within the airways, and adverse events are expected, including dislodging, mucus impaction, granulation tissue formation and infection.
Clinical case: 73-year-old male, bearer of silicone stent placed in the left main bronchi since 2003 due to an unspecified benign pathology, lost follow up (abandoned his routine stent surveillance and pulmonology consultation), but without record of any complication. On December 2020, the patient presented in the emergency department of our hospital with cough and dyspnea with 10 days evolution. A left lung infiltrate was evident on chest x-ray. SARS-Cov2 test was positive. He was admitted with the diagnosis of covid-19 pneumonia with hypoxemic respiratory insufficiency, treated with remdesivir, dexamethasone and high flow nasal oxygen. Because of persistent increase of inflammatory markers and different bacteria isolations on repeated sputum samples antibiotic therapy was initiated according to sensitivities. However, despite antibiotic escalations, the patient continued to have profuse bronchorrhea with need of twice daily respiratory physiotherapy, mild hypoxemic respiratory insufficiency, low-grade fever and discrete increase of inflammatory markers. Angio-CT showed persistency of lung consolidation on the left inferior lobe and on the right inferior lobe. Flexible bronchoscopy was performed showing the entrance of the left main bronchi partially occluded with nodular formations with granulation tissue appearance. The endobronchial stent was totally obstructed by purulent secretions which after thorough aspiration uncovered a degraded but patent prosthesis.There were thick mucopurulent secretions throughout endobronquial tree. After complete aspiration segmental and subsegmental bronchi became patent. Bronchial aspirate evidenced Stenotrophomonas Maltophilia and Acinetobacter Baumannii but also a positive PCR and culture for Mycobacterium Tuberculosis. Tuberculosis treatment was started together with co-trimoxazole according to antibiotic sensitivity. There was a good tolerability and clinical improvement with decreased amount of secretions, resolution of respiratory insufficiency and decrease of lung consolidation. Patient was referred for stent evaluation by rigid bronchoscopy (not available in our hospital).
Conclusion: This case evidences a rare example of a viral, bacterial and mycobacterial respiratory co-infection. Bronchoscopy not only allowed to effectively clear the lungs of profuse mucopurulent secretions, which in turn uncovered a bronchial prosthesis in very poor condition, but also to diagnose a “hidden” tuberculosis which could otherwise remain undiagnosed. Despite the advantages of a silicone endobronchial stent, one should keep in mind that follow up and maintenance are mandatory.
Figure 1: Endobronchial stent Figure 2: Entrance to the left main bronchus
72 6th European Congress for Bronchology and Interventional Pulmonology