A case of pulmonary actinomycosis in localized cystic bronchiectasis with repeated massive hemoptysis

Abstract

We present a case of endobronchial actinomycosis in localized cystic bronchiectasis, diagnosed after lobecotmy for recurrent massive hemoptysis. A 77-year-old woman showed massive hemoptysis occurring twice 1 year previously, and underwent bronchial artery embolization at another hospital. However, massive hemoptysis occurred again, and she was admitted to our hospital for examination. Chest computed tomography (CT) revealed a cavity lesion in the right laterobasal segment (S9), and the wall of the cavity showed gradual thickening. Fluorodeoxyglucose positron emission tomography (FDG-PET) showed high-level FDG accumulation in the cavity wall. A diagnosis of pulmonary aspergillosis or tuberculosis was ruled out, and we suspected primary lung cancer. To control hemoptysis, right lower lobectomy was performed. Pathological examination showed that the cavity wall was covered with ciliated epithelium, diagnosed as cystic bronchiectasis. In the dilated bronchus, sulfur granules were recognized and she was diagnosed with actinomycosis. The massive hemoptysis was considered to have been caused by not only bronchiectasis but also actinomycosis. Actinomycosis in localized cystic bronchiectasis has not previously been reported. In a case of hemoptysis with a pulmonary cavity lesion, endobronchial actinomycosis in the localized cystic bronchiectasis should be considered.