Non-resolving Pneumonia with Bronchorrhea

Introduction:
Non-resolving pneumonia after antibiotic treatment is encountered onquite a few occasions in clinical practice and is estimated to account for
approximately 15 percent of inpatient pulmonary consultations and 8 percent of bronchoscopies [1]. This is more frequently seen in intensive care/
ventilated patient-associated pneumonia compared to community-acquired pneumonia [2]. Treatment failures are mostly due to infectious causes,
and only 20% of the cases are due to noninfectious causes [3].


Case Presentation:
We present here an interesting case of non-resolving pneumonia. Our patient was a 58-year-old Middle Eastern descendant male who presented
with a cough with excessive mucoid sputum for 6 months. Chest radiology showed patchy consolidation in the right lower lobe, which gradually
progressed to multilobar consolidation over several months despite treatment with antibiotic antifungal and steroids. Extensive evaluation was done
with laboratory microbiological studies and bronchoscopy, but it was negative for tuberculosis and malignancy. So, the patient underwent an open
lung biopsy. Histopathology and immunohistochemical staining were suggestive of adenocarcinoma of the lung, predominant lepidic pattern, with
papillary, acinar patterns, and foci of invasion.


Conclusion:
This case is interesting because of its unique clinical presentation with bronchorrhea and progressive pneumonia. Also, it reveals the role of
surgical lung biopsy in navigating cases of difficult non-resolving pneumonia.
Nonresolving pneumonia with bronchorrhea