Metagenomic next-generation sequencing of bronchoalveolar lavage fluid unravels brucellosis in a patient with chronic lung disease and venous thrombosis: A case report.
- 1Department of Respiratory and Critical Medicine Zhongshan Hospital, Shanghai Key Laboratory of Lung Inflammation and Injury, Fudan University, Shanghai, China.
- 2Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
- 3Department of Gastrointestinal Surgery, The First Affiliated Hospital of Xinjiang Medical, Urumqi, Xinjiang, China.
Abstract
Background
Brucellosis is a re-emerging zoonosis in Xinjiang, China. Pulmonary involvement and thrombotic complications are rare but can be life-threatening. In patients with idiopathic pulmonary fibrosis (IPF), unexplained respiratory worsening poses a diagnostic dilemma: is it an acute exacerbation of IPF, community-acquired pneumonia, or a zoonotic infection? We report a case of chronic brucellosis in an IPF patient who developed lower extremity venous thrombosis, diagnosed by metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF), thereby resolving the clinical dilemma.Methods
A 57-year-old male farmer with IPF presented with progressive dyspnea and hypoxemia (SpO₂ 77% on room air). Serum Brucella agglutination test (SAT) and mNGS of BALF were performed.Results
SAT was positive at 1:800. mNGS of BALF detected 191 reads of Brucella spp. Lower extremity ultrasound revealed left calf muscular venous thrombosis. He was treated with doxycycline, rifampicin, and rivaroxaban. At one-month follow-up, his dyspnea had improved, and no recurrent thrombosis occurred.Conclusion
In endemic areas, brucellosis should be considered in IPF patients with unexplained respiratory worsening, even without typical fever. mNGS of BALF is a valuable diagnostic tool when blood cultures are negative. Clinicians should also be aware that severe infection and hypoxemia are risk factors for venous thrombosis.
Related
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BibTeX
@article{aji2026metagenomic,
title = {{Metagenomic next-generation sequencing of bronchoalveolar lavage fluid unravels brucellosis in a patient with chronic lung disease and venous thrombosis: A case report.}},
author = {Nurbiya Aji and Tuohetiaji Balati and ZengRong Yang and Bin Jia},
journal = {IDCases},
year = {2026},
month = sep,
doi = {10.1016/j.idcr.2026.e02786},
url = {https://europepmc.org/article/MED/42923920},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Metagenomic next-generation sequencing of bronchoalveolar lavage fluid unravels brucellosis in a patient with chronic lung disease and venous thrombosis: A case report.
AU - Nurbiya Aji
AU - Tuohetiaji Balati
AU - ZengRong Yang
AU - Bin Jia
PY - 2026
DA - 2026/09/30
JO - IDCases
DO - 10.1016/j.idcr.2026.e02786
UR - https://europepmc.org/article/MED/42923920
AB - Background Brucellosis is a re-emerging zoonosis in Xinjiang, China. Pulmonary involvement and thrombotic complications are rare but can be life-threatening. In patients with idiopathic pulmonary fibrosis (IPF), unexplained respiratory worsening poses a diagnostic dilemma: is it an acute exacerbation of IPF, community-acquired pneumonia, or a zoonotic infection? We report a case of chronic brucellosis in an IPF patient who developed lower extremity venous thrombosis, diagnosed by metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF), thereby resolving the clinical dilemma.Methods A 57-year-old male farmer with IPF presented with progressive dyspnea and hypoxemia (SpO₂ 77% on room air). Serum Brucella agglutination test (SAT) and mNGS of BALF were performed.Results SAT was positive at 1:800. mNGS of BALF detected 191 reads of Brucella spp. Lower extremity ultrasound revealed left calf muscular venous thrombosis. He was treated with doxycycline, rifampicin, and rivaroxaban. At one-month follow-up, his dyspnea had improved, and no recurrent thrombosis occurred.Conclusion In endemic areas, brucellosis should be considered in IPF patients with unexplained respiratory worsening, even without typical fever. mNGS of BALF is a valuable diagnostic tool when blood cultures are negative. Clinicians should also be aware that severe infection and hypoxemia are risk factors for venous thrombosis.
SN - 2214-2509
ER -