Aspiration pneumonia due to anesthesia digestive endoscopy under COVID-19: a case report

A woman was brought to the Emergency Department of the Center Hospital of Jinan because of fever. She got aspirated and developed severe shortness and chest pain. History of anesthesia digestive endoscopy 1 day ago, accompanied by vomiting. Her past medical history was unremarkable, she denied cigarette smoking, and has no history of allergy, anaphylaxis or bronchial asthma. Upon arrival at the hospital, she was connected to the monitor and put on humidified oxygen. On examination, she was severely distressed, blood pressure of 120/60mmHg, pulse rate of 108 beats per minute, oxygen saturation of 95% at room air, and respiratory rate of 26 breaths per minute, temperature of 39 degrees. On physical examination, wet rales were heard in the lower left lung. Blood gas analysis showed pH 7.45, partial pressure of carbon- dioxide 36.00 mmHg and partial pressure of oxygen 71.00 mmHg with 2 L/min oxygen via nasal cannula. The peripheral white blood cell count (9940/μL) and C-reactive protein level (78.5mg/h) were slightly high. The results of blood coagulation function test, biochemistry tests, myocardial enzymes, urinalysis and stool analysis were normal. Chest computed tomography revealed consolidation of the lower left lung. (Fig. 1)

Under COVID-19, in order to rule out the atypical pathogen infection and assist the patient in expulsion of inhaled substances, we performed tracheoscopy. Flexible bronchoscope showed injured and edematous surfaces of the large airways. Bronchoalveolar lavage was performed from the posterior segmental bronchus of the upper lower of her left lung. A cell count of the bronchoalveolar lavage fluid (BALF) revealed57.5% macrophages, 28.0% neutrophils, 11.0% lymphocytes, and 3.5% eosinophils. The total BALF cell count was 4.2 × 10⁶/mL. No bacteria or fungus was isolated from cultures of BALF. we collected BALF for testing of metagenomic next generation sequencing (mNGS). The result of mNGS was normal.

During hospitalization, the patient received piperacillin/ tazobactam to prevent bacterial pneumonia，hormonal anti-inflammatory and bronchodilators to improve the bronchospasm or wheezing.

After 7 days of medical treatment, the pneumonia subsided, blood, sputum cultures revealed negative findings. and she was discharged in a stable condition. The Fig. 2 was the chest CT of review.