title: [A case of pulmonary actinomycosis mimicking chronic necrotizing pulmonary aspergillosis].
abstract: A 60-year-old man was admitted to our hospital with fever, appetite loss, and fatigue. Chest X-ray films and computed tomography scans showed fungus-ball-like lesions in the thoracic cavity, and pleural thickening with surrounding infiltration in the left upper lobe, developing over several months. The white blood cell count (WBC) and serum C-reactive protein (CRP) levels of the patient at the time of admission were 8800/microl and 2.7 mg/dl, respectively. He showed a negative reaction for the serum Aspergillus precipitating antibody, and a positive reaction for the serum Aspergillus antigen (Pletelia Aspergillus) according to the new cut-off index (the result was 0.8). From these clinical findings, we diagnosed this lesion as chronic necrotizing pulmonary aspergillosis (CNPA) and administered anti-fungal drugs (itraconazole plus micafungin, voriconazole) for several months. Despite medication, his condition appeared to deteriorate, and Aspergillus was never confirmed from frequent sputum cultures and bronchial lavage specimens. Finally, a pneumectomy was performed. Histopathological findings revealed a Gram-positive, filament-form Actinomyces cluster inside the cavity, which we diagnosed pulmonary actinomycosis. In this case, there was a possibility that the serum aspergillus antigen showed a false-positive reaction. Case must be taken in the evaluation of serum Aspergillus antigen testing.
authors.affiliation: Department of Respirology, National Hospital Organization Fukuoka-Higashi Medical Center.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Kitasato
authors.forename: Shohei
authors.initials: S
authors.lastname: Takata
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Tao
authors.forename: Takaomi
authors.initials: T
authors.lastname: Koga
authors.forename: Asaka
authors.initials: A
authors.lastname: Takita
authors.forename: Kan
authors.initials: K
authors.lastname: Okabayashi
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kawasaki
authors.forename: Hisamichi
authors.initials: H
authors.lastname: Aizawa
mesh_terms: D000196:Actinomycosis / Q000175:diagnosis*; D002908:Chronic Disease; D003937:Diagnosis, Differential; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D055732:Pulmonary Aspergillosis / Q000175:diagnosis*