Pulmonary Actinomycosis Associated with Endobronchial Vegetable Foreign Body

Abstract

A 51-year-old woman visited our hospital with massive hemoptysis. She had suffered from recurrent hemoptysis for five years and had undergone bronchial artery embolization many times. The patient had a history of pulmonary tuberculosis and bronchiectasis. Chest radiography showed consolidation around the nodule in the lateral basal segment of the right lower lobe. We successfully performed a right lower lobectomy. The histological study of the resected specimen showed a vegetable foreign body and clumps of Actinomyces, indicating actinomycosis, which was suggested to be the cause of the hemoptysis. This was a very rare case of hemoptysis caused by a vegetable foreign body and actinomycosis.

Empyema associated with vegetable foreign body aspiration

“…[14] Some cases of AFB have been diagnosed and removed through surgery. [11] In our case, the first two bronchoscopies did not detect the bronchial foreign body. This indicates that in cases of suspected bronchial foreign bodies, the removal of granulation tissue is necessary to expose them in the deeper tissues.…”

“…However, 10%-20% of patients with special cases of AFBs, such as those with aspiration of vegetable matter, had normal radiographs. [9][10][11] In our case, the aspirated pepper was not detected on chest CT due to its small size and low density.…”

Pulmonary actinomycosis: cytomorphological features

“…They may cause infections when they cross epithelial barriers under certain conditions that produce low oxygen tension, mainly in cases of tissue necrosis [3]. Thus, these infections usually occur endogenously such as after trauma, surgery and, quite often due to the presence of foreign bodies [4][5][6][7][8]. In older people with poor buccal hygiene and/or dental disease, whether or not accompanied by alcoholism, aspiration of oropharyngeal secretions containing these bacilli is one of the main forms of disease acquisition [9], although hematogenous spread from a distant infectious focus would be another infrequent source of infection [10,11].…”