Surgical Management of Refractory Pulmonary Actinomycosis: A Case Report
Keywords:
Actinomycosis, Cardiothoracic surgery, Penicillin, Case report, Pulmonary actinomycosis, Lobectomy, Refractory hemoptysis, Antibiotic therapy, Surgical managementAbstract
Background: Pulmonary actinomycosis is an uncommon disease with a non-specific clinical presentation, challenging and usually leads to a misinterpretation of malignancy rather than infection.
Case: A 30-year-old female patient began her illness a year and a half ago with cough, chest pain, weakness, and hemoptysis. She received medical treatment; however, the episodes of hemoptysis persisted. A bronchoscopy was performed, where a mass was found, and a biopsy was taken. Subsequently, a diagnosis of pulmonary actinomycosis was made when sulfur granules with dystrophic calcification were found in the biopsy. Therefore, treatment with amoxicillin was given for 12 months. Three months later, she persisted with occasional hemoptysis, so it was decided to perform a right lung lobectomy, showing clinical improvement. After six months, the symptoms improved completely.
Conclusion: Since the introduction of penicillin, the incidence of pulmonary actinomycosis has decreased significantly to the point that only 94 cases were reported in the first decade of the 21st century. In addition to this, it is a great mimic of malignancy, being misdiagnosed as a pulmonary neoplasm. The most used treatment is penicillin for six to 12 months. Pulmonary lobectomy can be an effective treatment for refractory pulmonary actinomycosis with persistent hemoptysis despite prolonged antibiotic therapy. It is important to consider it among the differential diagnoses in patients with non-specific symptoms and a negative result for the most common pathogens.
Metrics
References
Wong VK, Turmezei TD. Actinomycosis. BMJ. 2011;343:d6099.
Suzuki M, Araki K, Matsubayashi S, Kobayashi K, Morino E, Takasaki J, et al. A case of recurrent hemoptysis caused by pulmonary actinomycosis diagnosed using transbronchial lung biopsy after bronchial artery embolism and a brief review of the literature. Ann Transl Med. 2019;7(5):1–6.
Brook I. Actinomycosis: diagnosis and management. South Med J. 2018;101(10):1019–23.
Boyanova L, Kolarov R, Mateva L, Markovska R, Mitov I. Actinomycosis: a frequently forgotten disease. Future Microbiol. 2015;10(4):613–28.
Mabeza GF, Macfarlane J. Pulmonary actinomycosis. Eur Respir J. 2003;21(3):361–73.
Kim SR, Jung LY, Oh IJ, Kim YC, Shin KC, Lee MK, et al. Pulmonary actinomycosis during the first decade of 21st century: cases of 94 patients. BMC Infect Dis. 2013;13:216.
Moniruddin A, Begum H, Nahar K. Actinomycosis: an update. Med Today. 2010;22(1):43–7.
Zhang M, Zhang XY, Chen YB. Primary pulmonary actinomycosis: a retrospective analysis of 145 cases in mainland China. Int J Tuberc Lung Dis. 2017;21(1):825–31.
Katsenos S, Galinos I, Styliara P, Galanopoulou N, Psathakis K. Primary bronchopulmonary actinomycosis masquerading as lung cancer: apropos of two cases and literature review. Case Rep Infect Dis. 2015;2015:609637.
Miller M, Haddad AJ. Cervicofacial actinomycosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;85(5):496–508.
Boot M, Archer J, Ali I. The diagnosis and management of pulmonary actinomycosis. J Infect Public Health. 2023;16(4):490–500.
Endo S, Murayama F, Yamaguchi T, Yamamoto S, Otani S, Saito N, et al. Surgical considerations for pulmonary actinomycosis. Ann Thorac Surg. 2002;74(1):185–90.
Song JU, Park HY, Jeon K, Um SW, Kwon OJ, Koh WJ. Treatment of thoracic actinomycosis: a retrospective analysis of 40 patients. Ann Thorac Med. 2010;5(2):80–5.
Aydin Y, Arslan R, Filik M. Pulmonary actinomycosis mimics lung cancer. Rev Soc Bras Med Trop. 2022;55:e0195.
Downloads
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2025 Mauricio Alejandro Saldaña-Ruiz, Jaime Eugenio Espinosa-Mora, Mauricio Linnery Rendón-Saldívar, Federico Ortiz-Alonso, Leopoldo David Trujillo-García
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
- Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
- The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
- Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site; with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.
- The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
- Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
- The Author represents and warrants that:
- the Work is the Author’s original work;
- the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
- the Work is not pending review or under consideration by another publisher;
- the Work has not previously been published;
- the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
- the Work contains no libel, invasion of privacy, or other unlawful matter.
- The Author agrees to indemnify and hold Publisher harmless from the Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.
Enforcement of copyright
The IJMS takes the protection of copyright very seriously.
If the IJMS discovers that you have used its copyright materials in contravention of the license above, the IJMS may bring legal proceedings against you seeking reparation and an injunction to stop you using those materials. You could also be ordered to pay legal costs.
If you become aware of any use of the IJMS' copyright materials that contravenes or may contravene the license above, please report this by email to contact@ijms.org
Infringing material
If you become aware of any material on the website that you believe infringes your or any other person's copyright, please report this by email to contact@ijms.org
