A case of pulmonary actinomycosis presented with endobronchial involvement

Abstract

Pulmonary actinomycosis is a rare infectious disease, which is characterized by a wide range of symptoms and no specific imaging findings and may be confused with neoplasia, tuberculosis or pneumonia. Endobronchial involvement of actinomycosis may be caused by aspiration of foreign bodies or broncholithiasis and may bronchoscopically masquerade as malignancy. A case of 68-year-old man is reported, who presented with productive cough and fever and had no response to antibiotic therapy with moxifloxacin. Patchy air-space consolidation on left lower lobe was demonstrated on CT and flexible bronchoscopy revealed an endobronchial white necrotized mass, causing partial occlusion of bronchus and masquerading as lung cancer. Endobronchial actinomycosis was confirmed by biopsies of lesion, which revealed radiating filamentous colonies of Actinomyces and no evidence of malignancy. The patient was successfully treated with intravenous penicillin G for two weeks, followed by doxycycline per oral for six months, achieving full resolution of lesion on follow-up CT and bronchoscopy and no recurrence of symptoms.

Hemoptisis masiva como complicación de actinomicosis pulmonar, un reporte de caso

“…The diagnosis is made by isolating the bacteria and through histological examination of a lung biopsy. Early detection offers a better prognosis for patients 7 . Normally, pulmonary actinomycosis has a good response to antibiotics, however, when presented with persistent hemoptysis (as in the case of our patient) or a complication such as bronchopleural fistula, surgery is indicated.…”

“…In about 20% of cases, surgical intervention is considered. This is done in patients who require resection of infected tissue (such as lung abscesses or empyemas that cannot be drained by simple aspiration), fistulas, sinuous tracts, failure of medical treatment, recurrence, impossibility of ruling out other diseases such as neoplasms, and in rare cases the presence of massive hemoptysis 7,11,12 .…”

Endobronchial actinomycosis

“…Buğra Kerget [1]  , Ferhan Kerget [2]  and Sevilay Özmen [3]  [1]. Ataturk University School of Medicine, Department of Pulmonary Diseases, Yakutiye, Erzurum, Turkey.…”

“…Before initiating treatment for hematologic malignancy, 6 × 4.000.000 units of crystallized penicillin were administered. Pulmonary actinomycosis remains a significant problem for clinicians due to the lack of specific symptoms and its similarity to other chronic sweeping chest diseases and malignancies 1,2 . Endobronchial actinomycosis is a rare condition, and histopathological evaluation invariably confirms its diagnosis.…”

Pulmonary actinomycosis: cytomorphological features

“…Aspiration of oropharyngeal secretions or the presence of a foreign body in the bronchial tree seems to be the main cause of pulmonary actinomycosis. Other forms of thoracic involvement include endobronchial disease, mediastinal infection, and pleural effusion [38][39][40][41]. The clinical (e.g.…”