Pulmonary Actinomycosis in a Patient with AIDS/HCV

Abstract

Pulmonary actinomycosis is a rare bacterial lung infection which is caused mainly by Actinomyces israelii. This non contagious infection can destroy parts of the lungs. There are variable presentations of pulmonary actinomycosis with similarity in manifestations to other infectious diseases of the lungs. Pulmonary actinomycosis is diagnosed by fine needle aspiration, bronchoscopy and finding of typical sulfur granules. We present a case of pulmonary actinomycosis in a middle aged (AIDS/HCV) man with massive hemoptysis and progressive dyspnoea. The bronchoscopy findings showed endobronchial mass with luminal occlusion in right upper lobe. Because of massive hemoptysis and poor response to conservative treatment and penicillin therapy, right upper lobectomy was needed to stop the bleeding. Histopathologic examination revealed the aggregations of filamentous Gram-positive organisms with characteristic pattern "sulfur granules", indicating actinomycosis. The patient was followed by six months of oral amoxicillin and has no recurrent hemoptysis.

Keywords: Hemoptysis; Immunodeficiency; Lung; Opportunistic infections.

[Table/Fig-1]:

The Chest X-ray shows interstitial infiltration.

[Table/Fig-2]:

HRCT images show large mass like consolidation in left upper lobe with central necrosis and excavation and also adjacent nodular infiltration (black arrows, complete report of HRCT is in the text).