Metagenomic next-generation sequencing of bronchoalveolar lavage fluid unravels brucellosis in a patient with chronic lung disease and venous thrombosis: A case report
Year: 2026
Type: article
Study design: Case Report
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.
Source: IDCases
Authors: Nurbiya Aji, Tuohetiaji Balati, ZengRong Yang, Bin Jia
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,370
OpenAlex ID: W7214973707