Case Presentation
A previously healthy one-year old boy, was admitted to our Department because of right lower lobe Pneumonia with moderate amount of right side pleural effusion(Fig. A1), He was treated with IV Cefuroxime resulting in a good clinical response, Three weeks later he was referred again due to left lower lobe Pneumonia(Fig.A2).
Due to two episodes of Pneumonia involving two different lungs within one month, a suspicion of an underlying immunodeficiency or other systemic disease was raised leading us to perform a wide investigation including blood Immunoglobulins levels that were within normal range.
Despite the absence of FBA history and the inappropriate clinical presentation (recurrent pneumonia not in the same side), FBA was still in our differential diagnosis so mainly due to the fact that those two episodes of Pneumonia occurred within a small period of time, A flexible bronchoscopy was performed which revealed a FB lodged at the entrance of left main bronchus(Fig.A3).
Discussion
In cases of recurrent Pneumonia that involved both lungs, FBA requires a high index of suspicion; Our assumption in this unusual case that the FB was stuck in the Carina, tilting and obstructing the entry of the right main Bronchus leading to right side Pneumonia, and in the second episode later on tilted to the left side and obstructed the left main Bronchus resulting in left sided Pneumonia(Fig.A4).
Conclusion
FBA should be highly considered in recurrent Pneumonia that involves two lungs especially when the episodes of Pneumonia occur within a short period of time.
