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Immunocompromised pneumonia — SCE Respiratory MCQ

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HardRespiratory InfectionsImmunocompromised pneumoniaSCE Respiratory

A 46-year-old woman on rituximab for vasculitis presents with fever, cough and hypoxaemia. CT shows bilateral ground-glass change with small nodules; neutrophils are normal and cultures are pending. Serum immunoglobulin G is 3.1 g/L. What is the most appropriate investigation?

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Correct answer: B — Bronchoscopy with bronchoalveolar lavage for bacterial, fungal, viral and Pneumocystis testing

An immunocompromised patient with diffuse infiltrates needs early microbiological sampling, and BAL can test for opportunistic pathogens including Pneumocystis, fungi and viruses. Peak flow, sleep study and bronchial challenge address airway or sleep disorders rather than acute immunocompromised pneumonia. Pleural aspiration is not indicated without a pleural collection.

Reference: BTS Bronchoscopy guidance; BHIVA Opportunistic Infection guidance