Endobronchial actinomycosis in a child.

Pediatr Pulmonol

Division of Anatomical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa.

Published: October 2021

Actinomycosis is a rare, indolent and invasive infection caused by Actinomyces species. Pulmonary actinomycosis is very rarely seen in the paediatric population. The classic radiological presentation of thoracic involvement of actinomycosis includes lower lobe consolidation, empyema and periostitis of the ribs. We report a case of endobronchial actinomycosis in a child diagnosed on endobronchial biopsy and bronchoalveolar lavage (BAL). Bronchoscopy can be dangerous when performed on these cases, as there is a risk of severe bleeding and large airway obstruction, as was the case with this patient.

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http://dx.doi.org/10.1002/ppul.25550DOI Listing

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Article Synopsis
  • Pulmonary actinomycosis is a rare lung infection caused by the bacterium Actinomyces and is often misdiagnosed as pulmonary tuberculosis or lung cancer due to its uncommon pulmonary presence.
  • Endobronchial actinomycosis, where the infection occurs in the bronchial tubes, is very rare, and there have been instances of broncholithiasis (calcium stones in the bronchial tubes) linked to it.
  • A case study of a 50-year-old male presenting with cough and hemoptysis (coughing up blood) revealed he had endobronchial actinomycosis with broncholithiasis, confirmed through a transbronchial biopsy.
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Introduction: Endobronchial foreign body aspiration is not common in adults, but it is a life-threatening event. Recurrent pneumonias by chronic retention of foreign body often lead to initial medical presentation of the patient. However, lymphoplasmacellular bronchitis with adenomatous hyperplasia and squamous epithelium metaplasia with complete or partial blockage of lobar bronchus mimicking lung tumor is rare in literature, and this particular condition is often misdiagnosed.

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A man in his 50s, with a history of night sweats and weight loss, presented acutely with dyspnoea and chest pain. Imaging revealed right middle lobe consolidation and a large pericardial effusion. The diagnosis of actinomycosis was made using endobronchial ultrasound-guided sampling from the pericardial effusion.

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