Institute of Clinical Medicine, University of Tsukuba, Tsukuba-City, Japan
Correspondence to: Hiroaki Satoh, MD, Division of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Tsukuba-City, Ibaraki 305-8575, Japan; e-mail: email@example.com
We read with interest the article by Chouabe et al (June 2002)1 on endobronchial actinomycosis associated with a foreign body. We would like to share our experience. A 75-year-old man presented with productive cough and fever. The chest radiograph revealed atelectasis in the right lower lobe. A thoracic CT scan showed calcified material in the right lower bronchus. Fiberoptic bronchoscopy revealed a granulomatous reaction in the right lower bronchus suggestive of a tumor almost obstructing the bronchial lumen, but the foreign body was not identified at the initial examination. Testing of an endobronchial biopsy specimen showed marked chronic inflammatory cell infiltration and proliferation of granulation tissue. The granulation tissue was tested by Gomori methenamine-silver stain and was positive for Actinomyces.
The patient was treated with penicillin G for 2 weeks. On follow-up bronchoscopy, the granulomatous lesion in the right lower bronchus had disappeared. At the end of this procedure, the patient coughed out a botanical seed, which was confirmed by microscopic examination. The calcified material in the right lower bronchus disappeared in the thoracic CT scan. For the adverse effect of penicillin G, the patient received erythromycin for 6 months. The condition of our patient was very similar to that of the patient in the report by Chouabe et al,1 and we can fully share their observations. Antibiotic therapy and also extraction of the foreign body are important for the treatment of patients with bronchial actinomycosis that is associated with the presence of a foreign body.
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