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Pulmonology Procedures |

Endobronchial Actinomycosis With Intrabronchial Metallic Foreign Body and Bronchiectasis

Hanna Meleth*, MBBS; Baburajan Kappedath, DM; Sakunthala Bhai, MD
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Jubilee Mission Medical College & Research Institute, Thrissur, India


Chest. 2012;142(4_MeetingAbstracts):894A. doi:10.1378/chest.1386709
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Abstract

SESSION TYPE: Bronchology Student/Resident Case Report Posters

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: Actinomycosis is a relatively rare infection met with in clinical practice. It can involve cervicofacial region, thorax and abdomen. Thoracic form often follows aspiration of oral contents. Primary endobronchial actinomycosis is extremely uncommon in association with foreign body aspiration. Previous reports have been due to organic material (1) and one report following aspiration of a shirt button (2). We present the case of a female who underwent lobectomy for intrabronchial foreign body with adjacent bronchiectasis. The histopathological examination revealed actinomycosis. This extremely uncommon presentation prompted this communication.

CASE PRESENTATION: Female, 46 years, presented with cough and hemoptysis of 4 month duration. She denied past history of pulmonary tuberculosis or aspiration. She was debilitated with significant loss of weight. There were occasional crackles in the right lower areas. No other abnormality was detected on clinical examination. Sputum for acid fast bacilli was negative. Computerised tomography (CT) of thorax showed an intrabronchial foreign body involving the medial basal segment of left lower lobe with adjacent bronchiectasis. She underwent left lower lobectomy and intra operatively it was found that the left lower lobe- medial basal, lateral and posterior segments were consolidated with the bronchus to the left lower lobe containing a metallic foreign body with bronchiectatic changes beyond the obstruction. Histopathology revealed actinomycosis with reactive changes in the lymph node (Fig 1). She was treated subsequently with tetracycline. Review one month after discharge showed complete recovery and marked improvement.

DISCUSSION: Two types of situations can predispose to actinomycosis- debilitated states such as non insulin dependent diabetes mellitus, neoplasm or poor dental hygiene and conditions that facilitate foreign body aspiration such as mental retardation (1). Our patient had none of the above. However more than 50% of patients may not give a history of choking (1).

CONCLUSIONS: Primary endobronchial actinomycosis must be considered in the differential diagnosis of an endobronchial mass and when there is a history of aspiration. The association of a metallic foreign body with actinomycosis have not been described so far to the best of our knowledge.

1) Stephane Choube et al; Endobronchial Actinimycosis Associated with Foreign Body- four cases and a review of literature; CHEST; 2002; 121 (6); 2069-72.

2) Walters G et al; Endobronchial Actinomycosis Associated with Aspiration of a Shirt Button- A 30 year latency; Respiratory Medicine CME; 2009; 2 (1); 18-20.

DISCLOSURE: The following authors have nothing to disclose: Hanna Meleth, Baburajan Kappedath, Sakunthala Bhai

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Jubilee Mission Medical College & Research Institute, Thrissur, India

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