Pulmonary actinomycosis complicating infliximab therapy for Crohn disease

Abstract

The use of anti-tumour necrosis factor (TNF) agents has expanded significantly over the past few years, particularly for rheumatological diseases and Crohn disease. A number of associated opportunistic infections have been observed as a result of suppression of T-cell-mediated immunity, the most frequent being tuberculosis. This report describes a case of pulmonary actinomycosis in a 52-year-old patient receiving regular infusions of infliximab, an anti-TNF agent, for Crohn disease. He presented with a 12-day history of fever, night sweats and a non-productive cough on a background of a 9-year history of Crohn terminal ileitis. There was radiological evidence of a left upper lobe non-cavitatory pneumonia and bronchoscopic lavage fluid eventually grew Actinomyces graevenitzii. The patient was hospitalised and improved with antibiotic therapy. Within 4 weeks there was almost complete radiological resolution and infliximab was restarted after 4 months without further complication.

Figure 1

CT scan showing left upper lobe consolidation without cavitation.

Figure 2

Endobronchial biopsy specimen showing actinomycotic mass with hyphae.