Correct!
1. Bronchoscopy with bronchoalveolar lavage
Bronchoscopy with bronchoalveolar lavage (BAL) is the procedure of choice in patients who have received a bone marrow transplant (1). It can be safely performed in most patients. Transbronchial biopsy (TBBx) can be performed but bone marrow transplant patients are often thrombocytopenic and TBBx usually adds little above BAL except for cytomegalovirus (CMV) pneumonia. Video-assisted thorascopic (VATS) biopsy can be performed but usually BAL is performed first and VATS performed later if the diagnosis is pursued. Following patients with serial CT scans should only be done with great caution. Immunocompromised patients can become critically ill rapidly and delay may increase the risk for diagnostic procedures. Needle biopsy can also be done but again patients are often thrombocytopenic and needle biopsy in disorders which compromise the pulmonary circulation can result in disastrous intrathoracic hemorrhage.
The BAL cultures showed E. coli, Legionella, rhinovirus, and adenovirus.
What should be done next?