Case Report
A 25-year-old woman with a 34-week and 5-day pregnancy, with a history
of astigmatism, consulted the emergency department, stating that in the
3 previous weeks she had presented with cough with hemoptysis, fatigue,
headache, odynophagia, and 6 kilogramme weight loss. On physical exam,
vital signs were within the normal ranges; a gravid uterus, foetal heart
rate, and foetal movements were present. Initially, the SARS-CoV2
antigen test was negative. However, chest radiography showed a lung mass
in the upper segment of the right lower lobe. Also, serial sputum smear
microscopy for tuberculosis was negative.
Given the persistence of symptoms, a polymerase chain reaction (PCR) to
SARS-CoV2 was performed with a positive result, confirming a mild acute
respiratory infection due to SARS-CoV2 that evolved satisfactorily with
management at home. Nevertheless, a high-resolution chest computed
tomography (CT) was taken, reporting a lung mass in the upper segment of
the right lower lobe adjacent to the horizontal pulmonary fissure of
origin to be determined (figure 1). Then, a sputum PCR was performed for
Mycobacterium tuberculosis and tuberculin test, which were negative, so
given the characteristics of the mass, tuberculosis or pulmonary mycosis
were discarded. The Pneumology service performed a fibrobronchoscopy and
bronchoalveolar lavage, obtaining a negative cytology for malignancy and
also a gramme stain, KOH test, smear microscopy for tuberculosis, and
PCR for mycobacteria with negative results, so the patient was
discharged with ambulatory management.
Ten days later, the patient was again consulted at the emergency
department due to the persistence of respiratory symptoms. A
high-resolution chest CT reported an increase in the lung lesion size
(figure 2), so she was hospitalized. A lung biopsy was performed by
interventional radiology after the pregnancy ended, draining purulent
material. Besides, the microscopical examination of this material
reported an acute bronchopneumonic process. The KOH test, Chinese ink,
and smear microscopy for tuberculosis studies were also performed with
negative results. However, the culture was positive, isolating a S.
intermedius with the usual antibiotic susceptibility profile. The
antibiotic management in the hospital was started with ceftriaxone and,
4 days later, given a good response to treatment, the patient was
discharged with amoxicillin for one month. After discharge, symptoms
resolved one week later, and tomographic findings reversed progressively
after 4 months (Figure 3).