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.
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Copyright (c) 2025 Mauricio Alejandro Saldaña-Ruiz, Jaime Eugenio Espinosa-Mora, Mauricio Linnery Rendón-Saldívar, Federico Ortiz-Alonso, Leopoldo David Trujillo-García
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