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Case Reports
. 2023 Sep 21;9(10):e20070.
doi: 10.1016/j.heliyon.2023.e20070. eCollection 2023 Oct.

Pulmonary actinomycosis mimicking lung malignancy: About two cases

Houda Rouis  1 , Chirine Moussa  1 , Aida Ayadi  2 , Amel Khattab  1 , Ibtihel Khouaja  1 , Ines Zendah  1 , Sonia Maâlej  1
Affiliations
Case Reports

Pulmonary actinomycosis mimicking lung malignancy: About two cases

Houda Rouis et al. Heliyon. .

Abstract

Pulmonary actinomycosis is a rare anaerobic infection with non specific clinical and radiographic presentations that delay diagnosis. Throughout literature, a significant number of misdiagnosed cases have been reported. The diagnosis is substantially based on histopathological pattern. We describe the cases of two patients evaluated and treated in pulmonary department 1 of Abderrahmane Mami hospital of Tunisia with a diagnosis of pulmonary actinomycosis. There are two men. The first patient had hypertension and chronic obstructive pulmonary disease and the second one underwent surgery for bronchiectasis. Clinical presentation was consistent with productive cough, hemoptysis, and deterioration of general status. The medical examination was non-specific. The chest X-ray revealed an apical opacity, excavated in the first case and retractable in the second one. Biology showed an inflammatory syndrome. Bronchoscopy was performed in the two cases and showed lesions mimicking lung malignancy. Diagnosis is confirmed by histopathological examinations of surgical specimens in the two cases. Both patients were received antibiotic therapy. The results were excellent with a favorable clinical course and no deaths. This study highlights the misleading patterns of actinomycosis to prompt accurate diagnosis and earlier treatment, thus improving the outcome. Given either its low culture yield or the limited use of new molecular diagnostic tools in routine clinical practice, histological examination of lung tissue specimens is crucial to get the correct diagnosis.

Keywords: Antibiotics; Histological examination; Lung cancer; Pulmonary actinomycosis.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Chest X-Ray film: left apical excavated opacity (arrows show the excavation).
Fig. 2
Fig. 2
Excavated left apical opacity noted by the white arrow.
Fig. 3
Fig. 3
CT view of excavated and liquefied tissue process (white arrow).
Fig. 4
Fig. 4
A bronchial lumen with actinomycosis seeds b suppurated necrotic foci with characteristic sulfur granules (x 160, HE stain).
See this image and copyright information in PMC

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