A 25-year-old woman with a 34-week and 5-day pregnancy, with a medical history of astigmatism, consulted the emergency department, stating that in the three previous weeks, she had presented with cough with hemoptysis, fatigue, headache, odynophagia, and 6 kg weight loss. On physical exam, vital signs were within the normal ranges, and a gravid uterus, fetal heart rate, and fetal movements were present. Initially, the severe acute respiratory syndrome coronavirus 2 (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 negative cytology for malignancy and also a Gram 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 by cesarean section at 34 weeks and 5 days of the patient's pregnancy, draining purulent material. The newborn was female, with expected anthropometric measurements in relation to her prematurity and an Apgar score of 8 at 1 min and 10 at 10 min. The newborn did not present complications after birth; however, it required a kangaroo mother care intervention program.
The microscopical examination of the purulent drained material from the lung lesion 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 1 month. After discharge, symptoms resolved 1 week later, and tomographic findings reversed progressively after 4 months (Figure 3).