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Endobronchial Actinomycosis Masquerading as Bronchogenic Carcinoma
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A5459 - Endobronchial Actinomycosis Masquerading as Bronchogenic Carcinoma
Author Block: A. Dheyab1, S. Toomey2, P. J. Oliveira3; 1Pulmonary , Allergy and Critical Care Medicine, University of Massachusetts, Worcester, MA, United States, 2Internal Medicine, University of Massachusetts, Worcester, MA, United States, 3University of Massachusetts, Sudbury, MA, United States.
Introduction: Pulmonary Actinomycosis is a chronic and slowly progressive infectious disease which is rare and often can be misdiagnosed. The infection arises from bacteria of the Actinomyces genus which are characterized as gram positive, filamentous, non spore forming facultative anaerobic bacilli. Actinomycosis infections classically involve either oral and cervicofacial infections, thoracic, or abdominopelvic anatomical regions. Pulmonary infection represent around 15% of Actinomycosis infections , while endobrnochial infection can be a diagnostic dilemma , as it would mimic bronchogenic cancer, and can cause bronchial obstruction with lung collapse. We report a case of endobronchial actinomycosis manifesting as a postobstructive pneumonia diagnosed via flexible fiberoptic bronchoscopy with endobronchial biopsy.
Case Description: This is a case of a 56 year old male with a medical history significant for COPD, insulin dependent type 2 diabetes, poor dentition and smoking history ,who initially presented with the symptoms of cough, and scant hemoptysis. He was found to have a right upper lobe opacity on chest x-ray, and was treated for community acquired pneumonia. His symptoms persisted despite antibiotic therapy, and surveillance x ray showed worsening of right upper lobe opacity. The patient had CT scan of the chest done , which showed right upper lobe consolidation with near total collapse of right upper lobe, right basilar consolidation. Flexible bronchoscopy was performed, showing occluded right upper lobe bronchus with endobronchial lesion. The lesion was biopsied. Rapid On Site Exam (ROSE) by pathology team examined the Fine needle aspirates , and their preliminary read was malignancy. Pathology demonstrating evidence of food particulates with dense sulfur granules morphologically consistent with actinomyces with atypical inflammatory cells. No cancer seen.
Discussion:In this case we report histologic evidence of endobronchial actinomycosis infection in a patient with mediastinal lymphadenopathy who presented with post obstructive pneumonia initially concerning for malignancy. Pulmonary infection may present in many different ways: pneumonia, pseudo tumor, bronchopleural fistula, and pulmonary abscess. Our case highlite the false positive potential of ROSE, which can occur in up to 5% of cases. The need for accurate diagnosis and allowing a healthy level of clinical suspicion to exclude diseases that can mimic Bronchogenic carcinoma , is the best way in avoiding unnecessarysurgeries and mobilities to patients .
References:
1.Kim SR. Pulmonary actinomycosis during the first decade of the 21st centruy2.Bennhoff DF. Actinomycosis: diagnostic and therapeutic considerations and a review of 32 cases. Laryngoscope. 1984;94(9):1198-1217.33.Valour F. Actinomycosis: etiology, clinical features, diagnosis, treatment, and management
Author Block: A. Dheyab1, S. Toomey2, P. J. Oliveira3; 1Pulmonary , Allergy and Critical Care Medicine, University of Massachusetts, Worcester, MA, United States, 2Internal Medicine, University of Massachusetts, Worcester, MA, United States, 3University of Massachusetts, Sudbury, MA, United States.
Introduction: Pulmonary Actinomycosis is a chronic and slowly progressive infectious disease which is rare and often can be misdiagnosed. The infection arises from bacteria of the Actinomyces genus which are characterized as gram positive, filamentous, non spore forming facultative anaerobic bacilli. Actinomycosis infections classically involve either oral and cervicofacial infections, thoracic, or abdominopelvic anatomical regions. Pulmonary infection represent around 15% of Actinomycosis infections , while endobrnochial infection can be a diagnostic dilemma , as it would mimic bronchogenic cancer, and can cause bronchial obstruction with lung collapse. We report a case of endobronchial actinomycosis manifesting as a postobstructive pneumonia diagnosed via flexible fiberoptic bronchoscopy with endobronchial biopsy.
Case Description: This is a case of a 56 year old male with a medical history significant for COPD, insulin dependent type 2 diabetes, poor dentition and smoking history ,who initially presented with the symptoms of cough, and scant hemoptysis. He was found to have a right upper lobe opacity on chest x-ray, and was treated for community acquired pneumonia. His symptoms persisted despite antibiotic therapy, and surveillance x ray showed worsening of right upper lobe opacity. The patient had CT scan of the chest done , which showed right upper lobe consolidation with near total collapse of right upper lobe, right basilar consolidation. Flexible bronchoscopy was performed, showing occluded right upper lobe bronchus with endobronchial lesion. The lesion was biopsied. Rapid On Site Exam (ROSE) by pathology team examined the Fine needle aspirates , and their preliminary read was malignancy. Pathology demonstrating evidence of food particulates with dense sulfur granules morphologically consistent with actinomyces with atypical inflammatory cells. No cancer seen.
Discussion:In this case we report histologic evidence of endobronchial actinomycosis infection in a patient with mediastinal lymphadenopathy who presented with post obstructive pneumonia initially concerning for malignancy. Pulmonary infection may present in many different ways: pneumonia, pseudo tumor, bronchopleural fistula, and pulmonary abscess. Our case highlite the false positive potential of ROSE, which can occur in up to 5% of cases. The need for accurate diagnosis and allowing a healthy level of clinical suspicion to exclude diseases that can mimic Bronchogenic carcinoma , is the best way in avoiding unnecessarysurgeries and mobilities to patients .
References:
1.Kim SR. Pulmonary actinomycosis during the first decade of the 21st centruy2.Bennhoff DF. Actinomycosis: diagnostic and therapeutic considerations and a review of 32 cases. Laryngoscope. 1984;94(9):1198-1217.33.Valour F. Actinomycosis: etiology, clinical features, diagnosis, treatment, and management
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