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- W2006876557 abstract "A 51-year-old Chinese woman without any significant past medical history was admitted in October 2003 for cough of 18 months' duration. There was minimal clear expectoration and no haemoptysis. She denied any shortness of breath, anorexia and weight loss. There were no symptoms of rhinitis, gastrooesophageal reflux or choking. She was afebrile with good dental hygiene. There were fine crepitations and localized rhonchi over the right lung base. Despite short courses of antibiotics from her general practitioner there was no improvement in her symptoms. The initial chest radiograph showed opacity in the right middle lobe with a subtle air-bronchogram. Blood investigations revealed an erythrocyte sedimentation rate of 113 mm/hr, and fasting and random blood glucose levels of 10.4 mmol/litre and 13.4 mmol/litre respectively. The full blood count, renal and liver function tests were within normal limits. Contrast enhanced chest computed tomogram (Figure 1) revealed a right middle lobe consolidation with air-bronchogram. A few pre-tracheal and subcarinal lymph nodes of less than 1 cm in diameter were present. Bronchoscopy showed nodular lesions causing subtotal occlusion of the middle lobe bronchus. Biopsy of these lesions revealed filamentous-like bacterial colonies which were Gram stain positive and modified Ziehl–Neelson stain negative with a background of acute and chronic inflammation consistent with actinomycosis. Bronchoalveolar lavage specimens were culture-negative. She was treated with intravenous benzylpenicillin 5 mega units 6-hourly for 1 month followed by oral penicillin V 1 g 6-hourly for 6 months. She returned to the clinic with complete resolution of symptoms 7 months after the treatment and a follow-up chest radiograph showed near complete resolution the right middle lobe opacity. Repeat bronchoscopy still showed nodular lesions in the right main bronchus which appeared much smaller now. The bronchoscope could now be passed beyond the lesion and a piece of ‘tissue’ was seen at the bifurcation of the middle bronchus. The ‘tissue’ was grasped with a biopsy forceps. However, it dropped above the vocal cords and most likely was swallowed by the patient. A repeat biopsy of the nodule showed persistence of actinomycosis. In addition, necrotic vegetative matter was present. Oral penicillin at the same dose was continued. Three months later, a third bronchoscopy showed complete resolution." @default.
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- W2006876557 date "2006-01-01" @default.
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- W2006876557 title "Endobronchial actinomycosis: is a repeat bronchoscopy after treatment necessary?" @default.
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- W2006876557 doi "https://doi.org/10.12968/hmed.2006.67.1.20327" @default.
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