Pulmonary Infiltrates, Airway Mucosal Lesions and Respiratory Microbiology After Freshwater Drowning: A Case Report

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ABSTRACT Early pulmonary abnormalities after freshwater drowning can be overinterpreted as bacterial pneumonia, especially when inflammatory biomarkers and respiratory microbiology are positive. A 20‐year‐old man was resuscitated after approximately 2 min of freshwater submersion. Day 1 chest CT showed bilateral lower‐lobe‐predominant opacities compatible with non‐cardiogenic pulmonary oedema and aspiration‐related lung injury, with near‐complete resolution by Day 25. Day 3 bronchoscopy showed diffuse, non‐removable, millet‐seed‐like whitish tracheal mucosal protrusions with hyperaemia and oedema, compatible with acute irritative airway injury. BALF mNGS detected multiple gram‐negative bacterial signals, predominantly Klebsiella pneumoniae , while sputum culture yielded ESBL‐negative, susceptible K. pneumoniae . Possible drowning‐associated pneumonia was considered because of aspiration, fever, markedly elevated inflammatory biomarkers and concordant microbiology; however, rapid radiological improvement and clinical stability suggested a substantial non‐infectious component. The patient recovered after an 8‐day course of piperacillin–tazobactam without antibiotic escalation, corticosteroids, mechanical ventilation or acute respiratory distress syndrome.

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