Metagenomic next-generation sequencing in the diagnose of pulmonary infection with airway complications in a lung transplant recipient

We reported a case of 60-year-old male with fever, cough, expectoration, and chest distress after right lung transplanted. Blood examination showed elevated C-reaction protein, white blood cell, ammonia. Computed tomography revealed patchy high-density shadows few pleural effusions in the transplanted lung. Bronchoscopy illustrated anastomotic fistula, pseudomembrane mucus plugs around main bronchial anastomosis. Carbapenem-resistant Klebsiella pneumoniae, Ureaplasma urealyticum, Aspergillus flavus was successively detected by metagenomic next-generation sequencing (mNGS). Targeted anti-microbial agents were administered patient successfully discharged. Unfortunately, year later, died respiratory failure due to recurrent pulmonary infections.