The utility of bronchoscopy in immunocompromised patients: a review

Abstract

Bronchoscopy is an important tool for the diagnosis of pulmonary disorders in immunocompromised patients. The addition of biopsies to bronchoalveolar lavage improves the diagnostic yield of non-infectious etiologies, although the underlying etiology of the immunocompromised state must be considered and may be influential. Certain unknowns remain, including timing of bronchoscopy and its impact on medical management and mortality. The ongoing role of non-invasive testing for infectious complications prior to bronchoscopy also remains to be defined. This review addresses the role of bronchoscopy in immunocompromised states related to underlying hematologic malignancies, prescription drug use or chemotherapy, and other disorders that predispose patients to infectious or non-infectious pulmonary diseases.

Keywords: Bronchoscopy; bronchoalveolar lavage; immunocompromised; metagenomics; next generation sequencing; opportunistic infections.

Figure 1

Various pulmonary findings in immunocompromised patients. (A) A chest CT in a patient with Nocardia and PJP; (B) PJP demonstrated via bronchoscopy utilizing toluidine blue and silver stain at >100× magnifications; (C) a PET-avid lung mass; (D) bronchoscopic findings in a patient with post-transplant lymphoproliferative disorder after renal transplant. CT, computed tomography; PET, positron emission tomography; PJP, Pneumocystis jirovecii pneumonia.