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Masif Pulmoner Hemorajinin Nadir Bir Nedeni: nvaziv Aktinomikoz [Respir Case Rep]
Respir Case Rep. 2018; 7(2): 86-89 | DOI: 10.5505/respircase.2018.72792

Masif Pulmoner Hemorajinin Nadir Bir Nedeni: nvaziv Aktinomikoz

Bilge Ylmaz Kara1, Mehmet Fatih necikli2, Melek Memolu1, Recep Bedir4, Uur Kostakolu3, Songl zyurt1, Gken Sevilgen5, ule Batk6, nal ahin1
1Recep Tayyip Erdoan niversitesi Tp Fakltesi, Gs Hastalklar Ana Bilim Dal, Rize
2Recep Tayyip Erdoan niversitesi Tp Fakltesi, Radyoloji Ana Bilim Dal, Rize
3Recep Tayyip Erdoan niversitesi Tp Fakltesi, Klinik Mikrobiyoloji ve Enfeksiyon Hastalklar Ana Bilim Dal, Rize
4Recep Tayyip Erdoan niversitesi Tp Fakltesi, Patoloji Ana Bilim Dal, Rize
5Recep Tayyip Erdoan niversitesi Tp Fakltesi, Gs Cerrahisi Ana Bilim Dal, Rize
6Recep Tayyip Erdoan niversitesi Tp Fakltesi, Anestezi ve Reanimasyon Ana Bilim Dal, Rize

Pulmoner aktinomikoz ge tan konulduunda lmle sonulanabilecek bir durumdur. Daha ok immn yetmezlii olan bireylerde beklenebilecei gibi immnkompetan kiilerde de grlebilecei unutulmamaldr. Bu yazda invazif pulmoner aktinomikoza bal masif pulmoner hemoraji gelien nadir bir olgu sunulmutur. Elli iki yanda bilinen immnsupresif durumu olmayan erkek hasta azdan balgamla kark kan gelmesi nedeni ile yatrld. Bronkoskopi planlanan hastann genel durumunda ani ktleme nedeni ile ekilen toraks bilgisayarl tomografisinde sol akcierde bavuruda olmayan total atelektazi saptand. Youn bakm nitesinde yaplan acil bronkoskopide sol ana brota masif hemoraji her iki ana bron mukozasnda yaygn nekrotik grnm izlendi. Alnan mukozal biyopsinin patolojik incelemesinde aktinomikozla uyumlu gram pozitif filamentz bakteri agregatlar izlendi. Broniyal arter kateterizasyonunda ekstravazasyon saptanan artere embolizasyon ilemi uyguland. Ancak takiplerinde gelien bilateral nekrotizan pnmoni nedeni ile hastann youn bakm takibine devam edildi. Hasta IV penisilin G ve anti fungal tedaviye ramen 40 gnlk takip sonrasnda kaybedildi. Masif pulmoner hemoraji olgularnda sklkla kanama yapan hastalklar ve tmoral lezyonlarn yokluunda ayrc tanda aktinomikoz gibi anjioinvazif enfeksiyonlar dnlmelidir.

Anahtar Kelimeler: aktinomikoz, masif pulmoner hemoraji, nekrotizan pnmoni

A Rare Cause of Massive Pulmonary Hemorrhage: Invasive Actinomycosis

Bilge Ylmaz Kara1, Mehmet Fatih necikli2, Melek Memolu1, Recep Bedir4, Uur Kostakolu3, Songl zyurt1, Gken Sevilgen5, ule Batk6, nal ahin1
1Recep Tayyip Erdogan University Faculty of Medicine, Department of Pulmonology, Rize, Turkey
2Recep Tayyip Erdogan University Faculty of Medicine, Department of Radiology, Rize, Turkey
3Recep Tayyip Erdogan University Faculty of Medicine, Department of Infectious Diseases, Rize, Turkey
4Recep Tayyip Erdogan University Faculty of Medicine, Department of Pathology, Rize, Turkey
5Recep Tayyip Erdogan University Faculty of Medicine, Department of Thoracic Surgery, Rize,Turkey
6Recep Tayyip Erdogan University Faculty of Medicine, Department of Anethesiology and Reanimation, Rize,Turkey

Pulmonary actinomycosis is a severe clinical condition that may cause death if unrecognized. It may occur in patients who were previously healthy or may develop in patients with chronic immunosuppressant conditions. Presently described is a rare case of massive pulmonary hemorrhage with a related angioinvasive Actinomyces infection. A 52-year-old formerly immunocompetent man was admitted to the hospital due to blood-streaked sputum. A computed tomography image of the thorax taken after the patients clinical status suddenly worsened revealed total collapse of the left lung. No tumoral lesion was observed, but extensive necrosis of the mucosa of both main bronchi with massive hemorrhaging in the left main bronchus was seen in an urgent bronchoscopy performed in the intensive care unit. A histopathological examination of the mucosal punch biopsy demonstrated aggregates of filamentous Gram-positive organisms indicating Actinomyces infection. Selective embolization of a branch of the feeding artery was successful to control the hemorrhage, but necrotizing pneumonia emerged and the patient could not be discharged from the intensive care unit. He was later lost despite 40 days of treatment with intravenous penicillin-G antifungal therapy. Pulmonary angioinvasive infections like actinomycosis must be kept in mind in the absence of bronchial carcinoma or other frequently encountered diseases in cases of massive pulmonary hemorrhage.

Keywords: actinomycosis, massive pulmonary hemorrhage, necrotising pneumonia

Olgunun Tomografi Kesitleri




Bilge Ylmaz Kara, Mehmet Fatih necikli, Melek Memolu, Recep Bedir, Uur Kostakolu, Songl zyurt, Gken Sevilgen, ule Batk, nal ahin. A Rare Cause of Massive Pulmonary Hemorrhage: Invasive Actinomycosis. Respir Case Rep. 2018; 7(2): 86-89

Sorumlu Yazar: Bilge Ylmaz Kara, Trkiye
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