Bronchoscopic innovations in managing atypical lung infections: A Case Series

<bold>Introduction:</bold> This case series illustrate the complexity of managing atypical lung infections that mimic more common pulmonary conditions (including malignancies)in immunocompetent patients. These cases also emphasize the critical role of bronchoscopic techniques in management. <bold>Case series:</bold> The 1st case describes the successful diagnosis and management of pulmonary rhinosporidiosis in a young farmer, with dyspnoea and hemoptysis. An endobronchial growth occluding the right main bronchus was identified, which was recanalized with a debulking tool, the microdebrider via rigid bronchoscopy. Biopsy revealed Rhinosporidium leading to effective treatment with oral Dapsone. The 2nd case is a 58/M, initially treated as sarcoidosis based on symptoms & HRCT scans showing mediastinal adenopathy, leading to steroid treatment that caused intestinal perforation. Methotrexate substitution also failed with the emergence of neurological symptoms and MRI brain hinting at possible tumor, which prompted a re-evaluation. Subsequent bronchoscopy/EBUS-TBNA with transbronchial biopsies and CSF analysis revealed Histoplasma capsulatum, prompting a switch to Liposomal Amphotericin B treatment, markedly improving his clinical status. The 3rd case is of a 60/M with right upper lobe cavitary lesion with a fungal ball. After an initial inconclusive BAL report and negative vasculitic panel, a Radial EBUS guided biopsy from the intracavitary mass was suggestive of pulmonary mucormycosis. The initiation of Liposomal Amphotericin B therapy led to significant improvement. <bold>Conclusion:</bold> This series reiterates a fact that rare infectious diseases can surprise anyone. Advanced bronchoscopic modalities help in management resulting in good outcomes