C43-07 Striking Gold: A Rare Bronchoscopy Finding in Acute Chest Syndrome

Abstract Acute chest syndrome is a serious and potentially life-threatening complication of sickle cell disease commonly encountered in hospitalized patients. It is broadly defined as the presence of a new pulmonary infiltrate on chest imaging in a patient with sickle cell disease, accompanied by respiratory symptoms and/or fever. This condition is a significant cause of morbidity and mortality and results from vaso-occlusion in the pulmonary microvasculature. Acute chest syndrome is most frequently triggered by a pain crisis but may also be caused by infections, particularly pneumonia. A 23-year-old female with hemoglobin SS sickle cell disease presented with shortness of breath and a productive cough. She had no recent pain crises and was not taking any home opioid for pain management. She had no history of stroke or acute chest syndrome and only experienced infrequent pain crises. Initial imaging revealed dense consolidation of the right lower lobe. Hemoglobin was 6.5 gm/dL, near the patient’s baseline. She was started on ceftriaxone, azithromycin, and corticosteroids for severe community acquired pneumonia. The hematology team initially opted against exchange transfusion. During her hospital course, the patient had persistent symptoms and increasing oxygen requirements. Repeat imaging showed continued opacification of the right lower lobe and new consolidation in the left lower lobe. An exchange transfusion was completed on day 5 of hospital admission. Due to worsening respiratory status and imaging findings, bronchoscopy was performed on day 6. It revealed a copious amount of thin, yellow fluid in both lower lobes. Bronchoalveolar lavage (BAL) was obtained from the right lower lobe and was similar in appearance. Analysis of the BAL fluid showed a lymphocytic predominance, with no growth on cultures. The patient completed a course of antibiotics and began to show clinical improvement. She was discharged home several days later. Acute chest syndrome is typically managed with oxygen supplementation, pain control, antibiotics, and either simple or exchange transfusion. While most cases respond well to conventional treatment, bronchoscopy may be considered in patients who are refractory to initial therapy. The presence of golden-yellow fluid during bronchoscopy is an unusual finding but has been reported in cases of acute chest syndrome. Previous case reports have documented similar fluid observed during bronchoscopy or in tracheal secretions. Although this distinct coloration was initially attributed to bilirubin, it may instead reflect a strongly exudative inflammatory process and supports the diagnosis of acute chest syndrome. This abstract is funded by: None