title: Hemoptysis as an early symptom of abdominal actinomycosis with thoracic extension ten years after cholecystectomy with retained gallstone.
abstract: BACKGROUND
  Thoracoabdominal actinomycosis is rare, especially in the context of readily available medical facilities.
  
  
  METHODS
  Case report and review of the literature.
  
  
  METHODS
  A 54-year-old male patient was admitted because of hemoptysis and a pulmonary infiltrate in the left lower lobe. His history was unremarkable except for chronic gastritis and an elective laparoscopic cholecystectomy performed 10 years earlier. Following persistent hemoptysis, elevated inflammatory markers, and a non-revealing bronchoscopy, a computed tomography scan of the thorax and upper abdomen revealed a tumor in the upper part of the left kidney spreading directly to the adjacent diaphragm and left lower lobe. Laparotomy revealed a granulomatous mass containing a gallstone, as well as orange granular content. The treatment involved surgical removal of the mass, splenectomy, excision of the infiltrated part of the left hemidiaphragm, and decortication of the left lower lobe. Because of a prolonged post-operative low-grade fever and radiologically confirmed encapsulation in the lingula, the patient was given ceftriaxone. Repeat bronchoscopy revealed Actinomyces meyeri. The initial antibiotic therapy was replaced with amoxicillin-clavulanic acid, after which the patient's health improved.
  
  
  CONCLUSIONS
  Actinomycosis is still a highly intriguing disease, as initial symptoms often mislead clinicians. It is important to consider the disease whenever we are challenged diagnostically or when risk factors are present.
authors.affiliation: Division of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb 10000, Croatia. agata.ladic@gmail.com
authors.forename: Agata
authors.initials: A
authors.lastname: Ladic
authors.forename: Igor
authors.initials: I
authors.lastname: Petrovic
authors.forename: Goran
authors.initials: G
authors.lastname: Augustin
authors.forename: Hrvoje
authors.initials: H
authors.lastname: Puretic
authors.forename: Mate
authors.initials: M
authors.lastname: Skegro
authors.forename: Ante
authors.initials: A
authors.lastname: Gojevic
authors.forename: Igor
authors.initials: I
authors.lastname: Nikolic
mesh_terms: D000196:Actinomycosis / Q000175:diagnosis*; D002763:Cholecystectomy / Q000009:adverse effects*; D042882:Gallstones / Q000175:diagnosis / Q000382:microbiology*; D006469:Hemoptysis / Q000175:diagnosis / Q000382:microbiology*; D006801:Humans; D059413:Intraabdominal Infections / Q000175:diagnosis / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed