2017 Volume 39 Issue 2 Pages 176-180
Background. Sometimes, the cause of respiratory failure cannot be determined by serology in immune suppressed patients, and bronchoscopy hence needs to be performed. However, performing bronchoscopy in patients with severe respiratory failure is sometimes difficult and associated with high risks. Case. A 60-year-old woman, who received prednisolone and methotrexate because of rheumatoid arthritis, visited a hospital due to dyspnea on effort. Positron emission tomography-computed tomography scan revealed diffuse consolidation and lung nodules, which showed fluorodeoxyglucose uptake. After she stopped taking methotrexate, the affected area in the lung worsened, and she was admitted to our hospital for severe respiratory failure. We were unable to determine the cause of respiratory failure by serology and hence performed flexible bronchoscopy during noninvasive positive pressure ventilation. There were no problems related to oxygenation or any complications during the bronchoscopy, and we were able to make the diagnosis of secondary organizing pneumonia due to rheumatoid arthritis. Treatment with corticosteroids was administered and was extremely effective; as a result, she became ambulatory and was discharged from the hospital. Conclusion. Bronchoscopy during noninvasive positive pressure ventilation may be a useful diagnostic method under sufficient risk management.
