Respir Case Rep. 2018; 7(2): 86-89 | DOI: 10.5505/respircase.2018.72792

A Rare Cause of Massive Pulmonary Hemorrhage: Invasive Actinomycosis

Bilge Yýlmaz Kara¹, Mehmet Fatih Ýnecikli², Melek Memoðlu¹, Recep Bedir⁴, Uður Kostakoðlu³, Songül Özyurt¹, Gökçen Sevilgen⁵, Þule Batçýk⁶, Ünal Þahin^1
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 patient’s 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

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Masif Pulmoner Hemorajinin Nadir Bir Nedeni: Ýnvaziv Aktinomikoz

Bilge Yýlmaz Kara¹, Mehmet Fatih Ýnecikli², Melek Memoðlu¹, Recep Bedir⁴, Uður Kostakoðlu³, Songül Özyurt¹, Gökçen Sevilgen⁵, Þule Batçýk⁶, Ünal Þahin^1
1Recep Tayyip Erdoðan Üniversitesi Týp Fakültesi, Göðüs Hastalýklarý Ana Bilim Dalý, Rize
²Recep Tayyip Erdoðan Üniversitesi Týp Fakültesi, Radyoloji Ana Bilim Dalý, Rize
³Recep Tayyip Erdoðan Üniversitesi Týp Fakültesi, Klinik Mikrobiyoloji ve Enfeksiyon Hastalýklarý Ana Bilim Dalý, Rize
⁴Recep Tayyip Erdoðan Üniversitesi Týp Fakültesi, Patoloji Ana Bilim Dalý, Rize
⁵Recep Tayyip Erdoðan Üniversitesi Týp Fakültesi, Göðüs Cerrahisi Ana Bilim Dalý, Rize
⁶Recep Tayyip Erdoðan Üniversitesi Týp Fakültesi, Anestezi ve Reanimasyon Ana Bilim Dalý, Rize

Pulmoner aktinomikoz geç taný konulduðunda ölümle sonuçlanabilecek bir durumdur. Daha çok immün yetmezliði olan bireylerde beklenebileceði gibi immünkompetan kiþilerde de görülebileceði unutulmamalýdýr. Bu yazýda invazif pulmoner aktinomikoza baðlý masif pulmoner hemoraji geliþen nadir bir olgu sunulmuþtur. Elli iki yaþýnda bilinen immünsupresif durumu olmayan erkek hasta aðýzdan balgamla karýþýk kan gelmesi nedeni ile yatýrýldý. Bronkoskopi planlanan hastanýn genel durumunda ani kötüleþme nedeni ile çekilen toraks bilgisayarlý tomografisinde sol akciðerde baþvuruda olmayan total atelektazi saptandý. Yoðun bakým ünitesinde yapýlan acil bronkoskopide sol ana broþta masif hemoraji her iki ana bronþ mukozasýnda yaygýn nekrotik görünüm izlendi. Alýnan mukozal biyopsinin patolojik incelemesinde aktinomikozla uyumlu gram pozitif filamentöz bakteri agregatlarý izlendi. Bronþiyal arter kateterizasyonunda ekstravazasyon saptanan artere embolizasyon iþlemi uygulandý. Ancak takiplerinde geliþen bilateral nekrotizan pnömoni nedeni ile hastanýn yoðun bakým takibine devam edildi. Hasta IV penisilin G ve anti fungal tedaviye raðmen 40 günlük takip sonrasýnda kaybedildi. Masif pulmoner hemoraji olgularýnda sýklýkla kanama yapan hastalýklar ve tümoral lezyonlarýn yokluðunda ayýrýcý tanýda aktinomikoz gibi anjioinvazif enfeksiyonlar düþünülmelidir.

Anahtar Kelimeler: aktinomikoz, masif pulmoner hemoraji, nekrotizan pnömoni

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Image Slices of the Case

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