Pulmonary actinomycosis – a diagnostic dilemma

Vladan  Živković; Sanja  Šarac; Svetlana Popović; Miloš Zarić; Saša  Ristić; Vanja  Kostovski; Jasna  Pešić; Bojan  Nikolić; Bojan  Rakonjac; Jelena  Vuković

doi:10.2298/VSP251104016Z

Vladan Živković Military Medical Academy, *Clinic for Pulmonology, Belgrade, Serbia
Sanja Šarac Military Medical Academy, *Clinic for Pulmonology, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Svetlana Popović Military Medical Academy, Clinic for Infectious and Tropical Diseases, Belgrade, Serbia
Miloš Zarić Military Medical Academy, Institute of Pathology and Forensic Medicine, Belgrade, Serbia
Saša Ristić Military Medical Academy, Institute of Pathology and Forensic Medicine, Institute of Radiology, Belgrade, Serbia
Vanja Kostovski Military Medical Academy, Clinic for Thoracic Surgery, Belgrade, Serbia
Jasna Pešić Military Medical Academy, Institute of Radiology, Belgrade, Serbia
Bojan Nikolić Military Medical Academy, Institute of Radiology, Belgrade, Serbia
Bojan Rakonjac Military Medical Academy, Institute of Microbiology, Belgrade, Serbia
Jelena Vuković Military Medical Academy, *Clinic for Pulmonology, Belgrade, Serbia; †University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP251104016Z

Keywords: actinomyces;, actinomycosis;, biopsy;, bronchoscopy;, diagnosis;, multidetector computed tomography;, thoracoscopy.

Abstract

Introduction. Pulmonary actinomycosis is a chronic inflammatory infectious disease caused by anaerobic and/or microaerophilic bacteria of the genus Actinomyces spp. It causes non-specific symptoms in the patient and gives an atypical clinical and radiographic presentation. It is extremely rare and is characterized by the formation of abscesses and fistulas in the lungs or local fibrosis. In the differential diagnosis, diseases and pathological conditions from tuberculosis to neoplastic processes in the lungs must be considered. Case report. We present a 39-year-old patient with an infiltrative lesion in the apex of the right lung and non-specific symptoms. In this patient, actinomycosis was pathohistologically proven after surgical intervention. Within a period of just over a month, a multi-detector computed tomography of the chest and bronchoscopy with transbronchial biopsy and bronchial swab were performed twice. Initially, pulmonary actinomycosis was not suspected. After an atypical resection of the tumor mass in the apex of the right lung and histopathologically proven infection, the patient was treated with antibiotic therapy for 6 months. Further examination was carried out to prove a potential primary or secondary immunodeficiency. Conclusion. Patients with non-specific changes in the lung parenchyma should also be suspected of having actinomycosis, and after diagnosis, it is necessary to supplement the examination to confirm or exclude immunodeficiency.

Author Biography

Sanja Šarac, Military Medical Academy, *Clinic for Pulmonology, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia

Klinika za pulmologiju

References

Oikonomidis P, Fousekis F, Kotsaftis P, Pilios I, Dimas D, Gian-noulis G. A case of pulmonary actinomycosis presented with endobronchial involvement. Respir Med Case Rep 2019; 28: 100930. DOI: 10.1016/j.rmcr.2019.100930.

Khoshbayan A, Amirmozafari N, Mirkalantari S. An overview of case reports and case series of pulmonary actinomycosis mim-icking lung cancer: a scoping review. Front Med (Lausanne) 2024; 11: 1356390. DOI: 10.3389/fmed.2024.1356390.

Baykal H, Ulger AF, Çelik D, Tanrikulu FB, Tatci E. Clinical and radiological characteristics of pulmonary actinomycosis mimicking lung malignancy. Rev Assoc Med Bras (1992) 2022; 68(3): 372−6. DOI: 10.1590/1806-9282.20211017.

Zhang N, Liu C, Kang L, Zhou J, Liu W, Qu X. A Case of Pul-monary Actinomycosis With Concurrent Gastric Adenocarci-noma in an Older Adult. Cureus 2024; 16(5): e60180. DOI: 10.7759/cureus.60180.

Yildiz O, Doganay M. Actinomycoses and nocardia pulmonary infections. Curr Opin Pulm Med 2006; 12(3): 228−34. DOI: 10.1097/01.mcp.0000219273.57933.48.

Moniruddin A, Begum H, Nahar K. Actinomycosis: an update. Med Today 2010; 22 (1): 43−7. DOI: 10.3329/medtoday.v22i1.5606.

Allan L, Said H, Shanks AM. Pulmonary actinomycosis pre-senting with empyema. BMJ Case Rep 2023; 16(11): e256320. DOI: 10.1136/bcr-2023-256320.

Mabeza GF, Macfarlane J. Pulmonary actinomycosis. Eur Respir J 2003; 21(3): 545−51. DOI: 10.1183/09031936.03.00089103.

Boot M, Archer J, Ali I. The diagnosis and management of pul-monary actinomycosis. J Infect Public Health 2023; 16(4): 490−500. DOI: 10.1016/j.jiph.2023.02.004.

Kim SR, Jung LY, Oh IJ, Kim YC, Shin KC, Lee MK, et al. Pul-monary actinomycosis during the first decade of 21st century: cases of 94 patients. BMC Infect Dis 2013; 13: 216. DOI: 10.1186/1471-2334-13-216.

Suzuki M, Araki K, Matsubayashi S, Kobayashi K, Morino E, Ta-kasaki J, et al. A case of recurrent hemoptysis caused by pul-monary actinomycosis diagnosed using transbronchial lung bi-opsy after bronchial artery embolism and a brief review of the literature. Ann Transl Med 2019; 7(5): 108. DOI: 10.21037/atm.2019.02.11.

Wong VK, Turmezei TD, Weston VC. Actinomycosis. BMJ 2011; 343: d6099. DOI: 10.1136/bmj.d6099.

Song JU, Park HY, Jeon K, Um SW, Kwon OJ, Koh WJ. Treat-ment of thoracic actinomycosis: a retrospective analysis of 40 patients. Ann Thorac Med 2010; 5(2): 80−5. DOI: 10.4103/1817-1737.62470.

Yuan Y, Hou Z, Peng D, Xing Z, Wang J, Zhang S. Pulmonary Actinomyces graevenitzii Infection: Case Report and Review of the Literature. Front Med (Lausanne) 2022; 9: 916817. DOI: 10.3389/fmed.2022.916817.

Ding X, Sun G, Fei G, Zhou X, Zhou L, Wang R. Pulmonary ac-tinomycosis diagnosed by transbronchoscopic lung biopsy: a case report and literature review. Exp Ther Med 2018; 16(3): 2554–8. DOI: 10.3892/etm.2018.6483.