Tuberc Respir Dis.  2007 Mar;62(3):227-231. 10.4046/trd.2007.62.3.227.

A Case of Secondary Organizing Pneumonia Associated with Endobronchial Actinomycosis

• Lee BH
• Lee KD
• Kim SH
• Woo JJ

• KMID: 1518469
• DOI: http://doi.org/10.4046/trd.2007.62.3.227

Abstract

Several types of infection can cause organizing pneumonia when the inflammatory process remains active with the further organization of the intra-alveolar fibrinous exudates, despite the control of the infectious organism by antibiotics. We report a case of 37-year-old male with secondary organizing pneumonia associated with an endobronchial actinomycosis. The patient presented with a subacute cough, sputum and fever. Bronchial biopsy revealed sulfur granule to be consistent with the actinomycosis, and percutaneous needle biopsy revealed typical pattern of organizing pneumonia. The patient was treated with the appropriate antibiotics and corticosteroid. There was rapid improvement in the symptoms and radiological findings, and after six months of treatment, the corticosteroid dose was tapered off without a recurrence of the organizing pneumonia.

Keyword

Bronchiolitis obliterans organizing pneumonia; Actinomycosis; Corticosteroids

MeSH Terms

Actinomycosis*
Adrenal Cortex Hormones
Adult
Anti-Bacterial Agents
Biopsy
Biopsy, Needle
Cough
Cryptogenic Organizing Pneumonia
Exudates and Transudates
Fever
Fibrin
Humans
Male
Pneumonia*
Recurrence
Sputum
Sulfur
Adrenal Cortex Hormones
Anti-Bacterial Agents
Fibrin
Sulfur

Figure

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  Figure 1 Chest PA. (A) Initial chest radiograph shows consolidative lesions of both upper lung. Opacity is more prominent in right side and adjacent to mediastinum in left side. (B) After treatment with corticosteroid and proper antibiotics for 2 months, opacity of both upper lung is markedly improved.

• 

  Figure 2 Computed tomography of chest. (A), (B) CT images obtained using lung window settings show consolidations with air-bronchogram in both upper lung. (C) Axial contrast-enhancd CT scan shows peribronchial and subpleural consolidations with internal low-attenuation foci(white arrows) in BUL. Mediasitnal adenopathy is also noted.

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  Figure 3 Bronchoscopy shows a white to yellowish endobronchial mass-like lesion obstructing the orifice of one subsegmental bronchus of the anterior segment of left upper lobe.

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  Figure 4 (A) Bronchoscopic biopsy specimen shows several irregularly shaped clumps of basophilic material to be consistent with sulfur granules (arrow) crushed by bronchoscopic biopsy procedure (H & E 200). (B) Percutaneous needle biopsy specimen shows a organizing pneumonia pattern that consists of intraalveolar buds of loose fibrous tissue and inflamed septa with slight fibrosis (×200, H & E stains).

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