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Pulmonary Actinomycosis in a Lung Transplant Recipient
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A5476 - Pulmonary Actinomycosis in a Lung Transplant Recipient
Author Block: M. Garcia1, R. P. Matos2, S. V. Campos1, J. Afonso1, A. Costa1, R. Carraro1, R. H. O. B. Teixeira1; 1Pulmonology Division, Heart Institute, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, Brazil, 2Heart Institute, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, Sao Paulo, Brazil.
Actinomycosis is a rare disease caused by an anaerobic Gram-positive bacteria that colonize the oropharynx, gastrointestinal and urogenital tracts. Since these microorganisms are not virulent, mucosal disruption is needed to lead to infection, which is characterized by capacity to invade surrounding tissues. This disease has been described in patients with diverse causes of immunodeficiency, but only few cases were described in solid organ transplant recipients. We describe here the case of a 69-year-old man that performed a bilateral lung transplantation ten years ago due to severe chronic obstructive pulmonary disease. He developed bilateral bronchial stenosis at anastomosis site and, therefore, he implanted bilateral endobronchial metallic prosthesis 9 months after the transplantation. At the hospital admission he complained of five days of progressive dyspnea, productive cough, fever and generalized myalgia. A physical examination revealed only a drop in pulse oximeter to 86%. A chest radiograph showed a nodular infiltrate in right inferior lung field. A chest computed tomography examination revealed a micronodular infiltrate with bronchiectasis, cavitation, pleural thickening and a small pleural effusion. Flexible bronchoscopy with bronchoalveolar lavage and biopsy was performed and the histopathological tissue analysis revealed organizing pneumonia with filamentous bacteria suggestive of Actinomyces spp. Treatment with amoxicillin was initiated and the patient showed clinical and tomographic improvement. Although actinomycosis is a rare infection after lung transplantation, physicians should always be aware of its possibility especially in recipients with endobronchial prosthesis.
Author Block: M. Garcia1, R. P. Matos2, S. V. Campos1, J. Afonso1, A. Costa1, R. Carraro1, R. H. O. B. Teixeira1; 1Pulmonology Division, Heart Institute, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, Brazil, 2Heart Institute, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, Sao Paulo, Brazil.
Actinomycosis is a rare disease caused by an anaerobic Gram-positive bacteria that colonize the oropharynx, gastrointestinal and urogenital tracts. Since these microorganisms are not virulent, mucosal disruption is needed to lead to infection, which is characterized by capacity to invade surrounding tissues. This disease has been described in patients with diverse causes of immunodeficiency, but only few cases were described in solid organ transplant recipients. We describe here the case of a 69-year-old man that performed a bilateral lung transplantation ten years ago due to severe chronic obstructive pulmonary disease. He developed bilateral bronchial stenosis at anastomosis site and, therefore, he implanted bilateral endobronchial metallic prosthesis 9 months after the transplantation. At the hospital admission he complained of five days of progressive dyspnea, productive cough, fever and generalized myalgia. A physical examination revealed only a drop in pulse oximeter to 86%. A chest radiograph showed a nodular infiltrate in right inferior lung field. A chest computed tomography examination revealed a micronodular infiltrate with bronchiectasis, cavitation, pleural thickening and a small pleural effusion. Flexible bronchoscopy with bronchoalveolar lavage and biopsy was performed and the histopathological tissue analysis revealed organizing pneumonia with filamentous bacteria suggestive of Actinomyces spp. Treatment with amoxicillin was initiated and the patient showed clinical and tomographic improvement. Although actinomycosis is a rare infection after lung transplantation, physicians should always be aware of its possibility especially in recipients with endobronchial prosthesis.
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