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• W2895778811 abstract "SESSION TITLE: Chest Infections 2 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Actinomycosis infection can affect multiple systems with one rare manifestation being primary endobronchial actinomycosis. We present a case of primary endobronchial actinomycosis associated with foreign body aspiration, which highlights the challenge in distinguishing it from malignancy. CASE PRESENTATION: A 70-year-old woman with history of diabetes mellitus and lifelong smoking presented with several months of dry cough and weight loss found to have a leukocytosis and right-sided opacity on chest x-ray. She was treated for pneumonia with symptomatic improvement. One month later, a chest CT done for lung cancer screening revealed a right lower lobe (RLL) consolidation, and she was treated with another course of antibiotics. She was followed with serial CT scans and her 6 month follow-up scan showed an enlarged consolidation in the RLL (Fig. 1A) with concern for an endobronchial lesion (Fig. 1B) as well as mediastinal lymphadenopathy. FDG-PET scan showed increased uptake in the RLL opacity. Flexible bronchoscopy revealed a yellowish endobronchial lesion obstructing the basilar segments of the RLL, which was easily removed with suction. Transbronchial needle aspiration was performed for the enlarged mediastinal lymph nodes. Gross pathology of the endobronchial lesion showed findings consistent with vegetable matter, which was the approximate size and shape of a corn kernel. Right lower lobe endobronchial biopsy showed squamous metaplasia and acute and chronic inflammation consistent with reaction to foreign body. Cytology of the R10 lymph node showed actinomyces on both GMS and gram staining. The patient completed an initial 6 weeks of IV ceftriaxone followed by an additional 16 weeks of oral penicillin with significant symptomatic and radiographic improvement (Fig. 1C). DISCUSSION: Foreign body-associated endobronchial actinomycosis is rare; we found only 24 reported cases in the literature. It usually presents as recurrent pneumonias with imaging concerning for a post-obstructive process similar to pulmonary malignancy [3, 4]. Because actinomycosis and malignancy can appear similar on CT and PET imaging [8, 9], even so far as to show mass-like endobronchial attenuation, as was the case with our patient, biopsy is critical in the workup of these lesions to rule out malignancy. Although mediastinal lymphadenopathy is common in pulmonary actinomycosis [5-7], biopsy confirmation of the organism in lymph nodes, as was seen in our case, has not, to our knowledge, been previously reported. Treatment of endobronchial actinomycosis traditionally involves a long course of antibiotics, which typically confers a good prognosis. CONCLUSIONS: Foreign body associated endobronchial actinomycosis shares many similarities in presentation and imaging with pulmonary malignancy. Biopsy should be done primarily to rule out malignancy. Reference #1: Thomas, M., T. Raza, and M.A. Langawi, A 37-Year-Old Man With Nonresolving Pneumonia and Endobronchial Lesion. Chest, 2015. 148(2): p. e52-e55. Reference #2: Park, J.Y., et al., Multivariate analysis of prognostic factors in patients with pulmonary actinomycosis. BMC Infect Dis, 2014. 14: p. 10. Reference #3: Ariel, I., et al., Endobronchial actinomycosis simulating bronchogenic carcinoma. Diagnosis by bronchial biopsy. Chest, 1991. 99(2): p. 493-5. Reference #4: Schweigert, M., et al., Pulmonary infections imitating lung cancer: clinical presentation and therapeutical approach. Ir J Med Sci, 2013. 182(1): p. 73-80. Reference #5: Valour, F., et al., Actinomycosis: etiology, clinical features, diagnosis, treatment, and management. Infect Drug Resist, 2014. 7: p. 183-97. Reference #6: Maki, K., et al., Endobronchial actinomycosis associated with a foreign body-successful short-term treatment with antibiotics. Intern Med, 2010. 49(13): p. 1293-6. Reference #7: Kim, S.R., et al., Pulmonary actinomycosis during the first decade of 21st century: cases of 94 patients. BMC Infect Dis, 2013. 13: p. 216. Reference #8: Qiu, L., et al., Pulmonary Actinomycosis Imitating Lung Cancer on (18)F-FDG PET/CT: A Case Report and Literature Review. Korean J Radiol, 2015. 16(6): p. 1262-5. Reference #9: Choi, H., et al., Pulmonary actinomycosis mimicking lung cancer on positron emission tomography. Ann Thorac Med, 2017. 12(2): p. 121-124. DISCLOSURES: No relevant relationships by Anas Ahmed, source=Web Response No relevant relationships by Jessica Channick, source=Web Response No relevant relationships by Maher Tabba, source=Web Response" @default.
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• W2895778811 date "2018-10-01" @default.
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• W2895778811 title "PULMONARY ACTINOMYCOSIS SECONDARY TO FOREIGN BODY MIMICKING A MALIGNANT ENDOBRONCHIAL LESION" @default.
• W2895778811 doi "https://doi.org/10.1016/j.chest.2018.08.104" @default.
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