Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium.
Department of Respiratory Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
BMC Pulm Med. 2020 Oct 22;20(1):275. doi: 10.1186/s12890-020-01312-6.
Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an ongoing pandemic that profoundly challenges healthcare systems all over the world. Fever, cough and fatigue are the most commonly reported clinical symptoms.
A 58-year-old man presented at the emergency department with acute onset haemoptysis. On the fifth day after admission, he developed massive haemoptysis. Computed tomography (CT) angiography of the chest revealed alveolar haemorrhage, more prominent in the left lung. Flexible bronchoscopy confirmed bleeding from the left upper lobe, confirmed by a bronchial arteriography, which was successfully embolized. Nasopharyngeal swabs (NPS) tested for SARS-CoV-2 using real-time polymerase chain reaction (RT-PCR) repeatedly returned negative. Surprisingly, SARS-CoV-2 was eventually detected in bronchoalveolar lavage (BAL) fluid.
Life-threatening haemoptysis is an unusual presentation of COVID-19, reflecting alveolar bleeding as a rare but possible complication. This case emphasises the added value of bronchoscopy with BAL in the diagnostic work-up in case of high clinical suspicion and negative serial NPS in patients presenting with severe symptoms.
由严重急性呼吸综合征冠状病毒 2 型（SARS-CoV-2）引起的 2019 年冠状病毒病（COVID-19）是一场持续的大流行，它给全世界的医疗系统带来了巨大的挑战。发热、咳嗽和疲劳是最常见的临床症状。
一名 58 岁男性因急性咯血到急诊科就诊。入院后第 5 天，他出现大量咯血。胸部 CT 血管造影显示肺泡出血，左肺更为明显。纤维支气管镜检查证实左上叶出血，支气管动脉造影证实，并成功栓塞。使用实时聚合酶链反应（RT-PCR）对鼻咽拭子（NPS）进行 SARS-CoV-2 检测，结果反复为阴性。令人惊讶的是，SARS-CoV-2 最终在支气管肺泡灌洗液（BAL）中被检测到。
危及生命的咯血是 COVID-19 的一种不常见表现，反映了肺泡出血是一种罕见但可能的并发症。本病例强调了在高度临床怀疑和连续 NPS 阴性的情况下，支气管镜检查联合 BAL 在诊断中的附加价值，适用于出现严重症状的患者。
