Post-flexible Bronchoscopy Escherichia coli Empyema: A Rare Complication or an Inflammatory Bacterial Translocation?

Empyema is an unusual complication of diagnostic bronchoscopy. We report a case of a male patient in his late 70s with bronchiectasis who developed a right lower lobe empyema 10 days after undergoing flexible bronchoscopy for incidentally detected lung nodules. Bronchial washings grew <i>Staphylococcus aureus</i> (<i>S. aureus</i>) and the atypical Gram-negative bacillus <i>Pantoea septica</i> (<i>P. septica</i>), while subsequent pleural fluid culture yielded <i>Escherichia coli</i> (<i>E. coli)</i>. This case highlights the risk of post-bronchoscopy infectious complications in patients with structural lung disease and illustrates how discordance between airway and pleural isolates can complicate antimicrobial decision-making.