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3. Bronchoscopy with bronchoalveolar lavage
The repeat CT scan does not show classic pneumonia but a few scattered central nodules and a "tree-in-bud" pattern. Although switching the antibiotics or adding anti-fungals is not wrong, there is no evidence of a fungal infection at this time. VATS seems overly aggressive in a non-immunocompromised host. Therefore, the best choice seems to be bronchoscopy with bronchoalveolar lavage.
Bronchoscopy revealed areas of marked bronchial erythema (Figure 3).
Figure 3. Selected views from the bronchoscopy showing areas of marked bronchial erythema.
A viral respiratory panel performed on the bronchoalveolar lavage fluid was negative. However, bacterial PCR was positive for Mycoplasma.
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