Collection of Lower Respiratory Specimen by Bronchoscopy for Diagnosis of COVID-19

Ng, Joyce K.C.; Ngai, Jenny C.L.; Ng, Susanna S.S.; Hui, David S.C.

Bronchoscopy, as an aerosol-generating procedure, is not routinely performed in patients with high-risk of coronavirus disease 2019 (COVID-19) owing to potential transmission to healthcare workers. However, obtaining lower respiratory specimens from bronchoscopy with bronchoalveolar lavage (BAL) is necessary to confirm COVID-19 or other diagnosis that will change clinical management. We report a case with diagnostic difficulty with five negative SARS-CoV-2 RT-PCR testing in four upper respiratory tract and one stool samples following presentation with fever during the quarantine period and a strong epidemiological linkage to an index patient with COVID-19. The final diagnosis was confirmed by BAL. Special precautions when performing bronchoscopy in high-risk non-intubated patients were discussed.