A case of pulmonary actinomycosis diagnosed by imprint and squashed specimen cytology

Abstract

Background: We report a case of pulmonary actinomycosis diagnosed by imprint and squashed specimen cytology.
Case: A 22-year old woman reported left anterior chest pain and fever since February 1999. Chest X-ray and chest computed tomography (CT) scan showed an infiltrative shadow and pleural effusion due to pneumonia with pleuritis. She suffered from hemoptysis during treatment and was admitted to the hospital. Sputum cultures showed normal flora and sputum cytology was negative for malignant disease. It is often very difficult to diagnose pulmonary actinomycosis clinically. Transbronchial lung biopsy failed to establish a diagnosis. Due to frequent hemoptysis, a lobectomy of left lower lobe was conducted. Imprint and squashed cytological examination revealed Actinomyces organisms in clusters. The cytological features of Actinomyces organisms were aggregated “sulfur granules” forming irregular islands of amorphous clumps. Large aggregates were green to brown, with numerous filamentous structures radiating from the center.
Conclusion: Close observation of sulfur granules from fresh specimens obtained by cytological examination is very important in diagnosing pulmonary actinomycosis.