Kosin Med J.  2013 Dec;28(2):155-160. 10.7180/kmj.2013.28.2.155.

A Case of Endobronchial Actinomycosis with a Broncholith cured by Cryotherapy through a Flexible Bronchoscope

• Yoo JS
• Cho EJ
• Gwoo S
• Kwon HJ
• Lim SK
• Jang TW
• Oak CH

• KMID: 1993574
• DOI: http://doi.org/10.7180/kmj.2013.28.2.155

Abstract

We report the case of a 53-year-old man who presented with obstructive pneumonitis and broncholithiasis. We attempted to remove the broncholith with forceps through a flexible endoscope, but the potential for bleeding due to partial synechia did not allow this. We succeeded in removing it with cryotherapy. The histopathological diagnosis was thoracic actinomycosis associated with broncholithiasis. Endobronchial actinomycosis with a broncholith is very rare. We successfully treated a patient with endobronchial actinomycosis with a broncholith by administering short-term antibiotics after broncholithectomy via cryotherapy through a flexible bronchoscope.

Keyword

Actinomycosis; Broncholith; Bronchoscopy; Cryotherapy

MeSH Terms

Actinomycosis*
Anti-Bacterial Agents
Bronchoscopes*
Bronchoscopy
Cryotherapy*
Diagnosis
Endoscopes
Hemorrhage
Humans
Middle Aged
Pneumonia
Surgical Instruments
Anti-Bacterial Agents

Figure

• 

  Fig. 1. Chest radiograph shows focal infiltration in the right middle lobe.

• 

  Fig. 2. Chest CT shows a calcified stone in the bronchus and atelectasis in the right middle lobe.

• 

  Fig. 3. Bronchoscopy shows near-total obstruction of the right middle lobe by broncholith.

• 

  Fig. 4. There were no specific findings at follow-up bronchoscopy 5 days after the cryotherapy procedure.

• 

  Fig. 5. The bronchoscopic biopsy showed marked lymphocyte infiltration and a few calcified fragments with radiating filamentous basophilic bacterial colonies (H&E, × 40).

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  Fig. 6. There were no specific findings at follow-up bronchoscopy 8 weeks after the cryotherapy procedure.

Reference

1.Lee YK., Lee HS., Oh MH., Choi JS., Seo KH., Kim YH, et al. Two Cases of Endobronchial Actinomycosis that were Cured by Operation and Short Term Antibiotics Therapy. Tuberc Respir Dis. 2008. 65:125–30.

2.Choi JC., Koh WJ., Kwon YS., Ryu YJ., Yu CM., Jeon K, et al. Diagnosis and Treatment of Endobronchial Actinomycosis. Tuberc Respir Dis. 2005. 58:576–81.

3.Park JO., Ryu JW., Park S., Kim SH., Seo PW. Broncholithiasis caused by actinomycosis. Korean J Thorac Cardiovasc Surg. 2006. 39:236–9.

4.Watanabe N., Nakajima I., Kunikane H., Sukoh N., Takekawa H., Ogura S, et al. A case of bronchial actinomycosis associated with bronchoscopically removed broncholith. Nihon Kyobu Shikkan Gakkai Zasshi. 1992. 30:441–6.

5.Russo TA. 156. Actinomycosis. Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, editors. editors.Harrison's principles of internal medicine. 17th ed.New York: McGraw hill;2008. p. 996–9.

6.Dalhoff K., Wallner S., Finck C., Gatermann S., Wiessmann KJ. Endobronchial actinomycosis. Eur Respir J. 1994. 7:1189–91.

7.Hsieh MJ., Liu HP., Chang JP., Chang CH. Thoracic actinomycosis. Chest. 1993. 104:366–70.

8.Lee SY., Oh HC., Jeon CW., Lee SJ., Lee CS., Lee KR, et al. Thoracicl Actinomycosis Associated with Broncholithiasis: Report on 2 cases. Korean J Thorac Cardiovasc Surg. 2008. 41:390–4.

9.Tsubochi H., Endo S., Suhara K., Sohara Y. Endobronchial aspergillosis and actinomycosis associated with broncholithiasis. Eur J Cardiothorac Surg. 2007. 31:1144–6.

10.Kim TS., Han J., Koh WJ., Choi JC., Chung MJ., Lee KS, et al. Endobronchial actinomycosis associated with broncholithiasis: CT findings for nine patients. AJR Am J Roentgenol. 2005. 185:347–53.

11.Seo JB., Lee JW., Ha SY., Park JW., Jeong SH., Park GY. Primary endobronchial actinomycosis associated with broncholithiasis. Respiration. 2003. 70:110–3.

12.Cheon JE., Im JG., Kim MY., Lee JS., Choi GM., Yeon KM. Thoracic actinomycosis: CT findings. Radiology. 1998. 209:229–33.

13.Maki K., Shinagawa N., Nasuhara Y., Oizumi S., Domen H., Haga H, et al. Endobronchial actinomycosis associated with a foreign body--successful short-term treatment with antibiotics--. Intern Med. 2010. 49:1293–6.

14.Reddy AJ., Govert JA., Sporn TA., Wahidi MM. Broncholith removal using cryotherapy during flexible bronchoscopy: a case report. Chest. 2007. 132:1661–3.

15.Olson EJ., Utz JP., Prakash UB. Therapeutic bronchoscopy in broncholithiasis. Am J Respir Crit Care Med. 1999. 160:766–70.