Organizing pneumonia due to actinomycosis: an undescribed association.
Organizing pneumonia is a pathologic entity characterized by intra-alveolar buds of granulation tissue that can extend to the bronchiolar lumen. It is a non-specific finding reflecting a pattern of pulmonary response to aggression that can be cryptogenic or associated with several causes. Pulmonary actinomycosis is a rare infectious disease, of bacterial aetiology, and of difficult diagnosis. This disease usually causes non-specific respiratory symptoms and radiological findings, and the treatment is based on the use of antibiotics. The authors describe a clinical case of a 53-year-old male smoker (50 pack years), initially seen for complaints of right-sided chest pain and sub-febrile temperature. Imaging studies revealed a mass in the inferior right lobe and enlarged mediastinal lymph nodes. Empirical treatment with antibiotics caused partial and temporary improvement. Transthoracic biopsy revealed a pattern of organizing pneumonia with giant multinucleated cell granulomas. Repeat imaging studies revealed an enlargement of the pulmonary mass and therefore a right inferior lobectomy was performed. The pathologic study revealed a histological pattern of organizing pneumonia surrounding inflammatory bronchiectasis with a large number of Actinomyces colonies. To our knowledge there is presently no report in the literature of organizing pneumonia associated with Actinomyces infection.
Centre of Pulmonology of Coimbra University Medical School, University Hospital of Coimbra, Coimbra, Portugal. alfarotm @ gmail.com
T M
TM
Alfaro
J
J
Bernardo
H
H
Garcia
F
F
Alves
L
L
Carvalho
F
F
Caseiro Alves
C
C
Robalo Cordeiro
D000196:Actinomycosis / Q000150:complications*; D001987:Bronchiectasis / Q000150:complications; D018549:Cryptogenic Organizing Pneumonia / Q000209:etiology* / Q000382:microbiology* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D006101:Granuloma, Giant Cell / Q000150:complications / Q000473:pathology; D006801:Humans; D008171:Lung Diseases / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D012129:Respiratory Function Tests; D014057:Tomography, X-Ray Computed