Scientific Letter
Actinomycosis Associated with Foreign Body Simulating Lung Cancer
Actinomicosis sobre cuerpo extraño que simula una neoplasia pulmonar
Stephany Laguna
, Iker Lopez, Jon Zabaleta, Borja Aguinagalde
Corresponding author
Servicio de Cirugía Torácica, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, Spain
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(B) Acute and chronic inflammation, forming focal abscesses, associated with a foreign body (fish bone), with <span class="elsevierStyleItalic">Actinomyces</span> superinfection, fibrosis and perilesional reactive changes.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Pulmonary actinomycosis is a necrotizing lung infection that can develop after aspiration of a foreign body. Approximately 50% of cases can mimic lung cancer.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 76-year-old women diagnosed with right lower lobe (RLL) pneumonia in September 2014, treated with azithromycin 500<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>hours for 1 week. After completing the course of antibiotics, she consulted due to dyspnea accompanied by cough with foul-smelling whitish sputum and fever. A chest computed tomography was performed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A), which showed heterogeneous pulmonary consolidation in the RLL, with no evidence of any obstructive central lesion. The patient received another cycle of antibiotics with amoxicillin/clavulanate acid (1000/200<span class="elsevierStyleHsp" style=""></span>tid) for 14 days.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">In September 2015, she presented with hemoptysis, and fiberoptic bronchoscopy was performed, revealing a “fibrin plug in a medial subsegment of the RLL”. Bronchial angiogram revealed a hypervascularized lesion in the right hilum, irrigated by a right bronchial artery originating in an intercostal trunk. The study was completed with a PET/CT, which showed the lesion in the RLL with a maximum standardized uptake value (SUV) of 4. Given the high suspicion of malignancy and the episode of hemoptysis, we decided to perform a surgical intervention. In view of the location of the lesion, right lower lobectomy was performed by thoracotomy.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The pathology report described mixed acute and chronic inflammation, forming focal abscesses, associated with a foreign body (fish bone), with <span class="elsevierStyleItalic">Actinomyces</span> superinfection, fibrosis and perilesional reactive changes (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B).</p><p id="par0025" class="elsevierStylePara elsevierViewall">Actinomycosis is a chronic suppurative infection caused by a group of anaerobic bacteria that are normally found in the flora of oropharynx and gastrointestinal tract. Approximately 15%–20% of cases diagnosed are located in the chest.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> The main symptoms associated with actinomycosis are: cough (63%), hemoptysis (36%) and recurrent pneumonias (27%).<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Most patients are men, over 55 years of age, with risk factors for aspiration pneumonia, such as diabetes mellitus, alcoholism, and poor dental hygiene.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Pulmonary actinomycosis can mimic a malignant pulmonary process, so in some cases surgery is performed. Bates and Cruickshank<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4,5</span></a> published 85 cases of pulmonary actinomycetes, of which 7 underwent lung resection due to a clinical suspicion of lung cancer.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Treatment of pulmonary actinomycosis consists of prolonged intravenous antibiotic therapy with high-dose penicillin, for 3–4 weeks. Prognosis is generally more favorable when it is diagnosed and treated early.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In patients with pulmonary lesions without a confirmed diagnosis of cancer, actinomycosis, even though it is rare, should feature in the differential diagnosis, particularly if there is a possibility that the patient may have aspirated a foreign body. Our case was a patient with a lung lesion caused by pulmonary actinomycosis after bronchoaspiration of a fish bone (not documented in her medical records) that mimicked a malignant process of the lung.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Laguna S, Lopez I, Zabaleta J, Aguinagalde B. Actinomicosis sobre cuerpo extraño que simula una neoplasia pulmonar. Arch Bronconeumol. 2017;53:284–285.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 571 "Ancho" => 1500 "Tamanyo" => 143328 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Heterogeneous pulmonary consolidation in the right lower lobe, with no evidence of central lesion, associated with mural thickening. (B) Acute and chronic inflammation, forming focal abscesses, associated with a foreign body (fish bone), with <span class="elsevierStyleItalic">Actinomyces</span> superinfection, fibrosis and perilesional reactive changes.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endobronchial actinomycosis associated with foreign body: four cases and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Chouabe" 1 => "D. Perdu" 2 => "G. Deslée" 3 => "D. Milosevic" 4 => "E. Marque" 5 => "F. 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Park" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "T Korean J Intern Med" "fecha" => "2002" "volumen" => "17" "paginaInicial" => "207" "paginaFinal" => "210" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005300000005/v1_201704280925/S157921291730085X/v1_201704280925/en/main.assets" "Apartado" => array:4 [ "identificador" => "49861" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005300000005/v1_201704280925/S157921291730085X/v1_201704280925/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157921291730085X?idApp=UINPBA00003Z" ]
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| 2024 February | 34 | 20 | 54 |
| 2023 March | 14 | 3 | 17 |
| 2023 February | 46 | 17 | 63 |
| 2023 January | 36 | 33 | 69 |
| 2022 December | 58 | 44 | 102 |
| 2022 November | 61 | 36 | 97 |
| 2022 October | 64 | 40 | 104 |
| 2022 September | 46 | 19 | 65 |
| 2022 August | 44 | 42 | 86 |
| 2022 July | 58 | 43 | 101 |
| 2022 June | 36 | 33 | 69 |
| 2022 May | 40 | 27 | 67 |
| 2022 April | 58 | 41 | 99 |
| 2022 March | 44 | 45 | 89 |
| 2022 February | 62 | 33 | 95 |
| 2022 January | 55 | 30 | 85 |
| 2021 December | 51 | 65 | 116 |
| 2021 November | 48 | 37 | 85 |
| 2021 October | 61 | 45 | 106 |
| 2021 September | 33 | 45 | 78 |
| 2021 August | 41 | 34 | 75 |
| 2021 July | 31 | 28 | 59 |
| 2021 June | 40 | 31 | 71 |
| 2021 May | 50 | 40 | 90 |
| 2021 April | 100 | 81 | 181 |
| 2021 March | 52 | 18 | 70 |
| 2021 February | 34 | 26 | 60 |
| 2021 January | 35 | 16 | 51 |
| 2020 December | 44 | 21 | 65 |
| 2020 November | 31 | 20 | 51 |
| 2020 October | 150 | 19 | 169 |
| 2020 September | 83 | 14 | 97 |
| 2020 August | 81 | 13 | 94 |
| 2020 July | 114 | 17 | 131 |
| 2020 June | 63 | 11 | 74 |
| 2020 May | 42 | 13 | 55 |
| 2020 April | 33 | 21 | 54 |
| 2020 March | 26 | 13 | 39 |
| 2020 February | 37 | 13 | 50 |
| 2020 January | 28 | 13 | 41 |
| 2019 December | 33 | 14 | 47 |
| 2019 November | 30 | 24 | 54 |
| 2019 October | 41 | 12 | 53 |
| 2019 September | 16 | 13 | 29 |
| 2019 August | 31 | 13 | 44 |
| 2019 July | 24 | 23 | 47 |
| 2019 June | 33 | 11 | 44 |
| 2019 May | 32 | 12 | 44 |
| 2019 April | 33 | 27 | 60 |
| 2019 March | 26 | 15 | 41 |
| 2019 February | 32 | 14 | 46 |
| 2019 January | 22 | 12 | 34 |
| 2018 December | 25 | 8 | 33 |
| 2018 November | 60 | 13 | 73 |
| 2018 October | 72 | 13 | 85 |
| 2018 September | 20 | 7 | 27 |
| 2018 May | 10 | 0 | 10 |
| 2018 April | 35 | 7 | 42 |
| 2018 March | 50 | 6 | 56 |
| 2018 February | 42 | 5 | 47 |
| 2018 January | 105 | 5 | 110 |
| 2017 December | 55 | 6 | 61 |
| 2017 November | 21 | 12 | 33 |
| 2017 October | 16 | 5 | 21 |
| 2017 September | 23 | 6 | 29 |
| 2017 August | 23 | 15 | 38 |
| 2017 May | 2 | 0 | 2 |
Show all
