Okuda Ryo, Izumo Takehiro, Yoshikawa Mitsuhiro, Kakuta Yumi, Tamaoki Jun, Nagai Atsushi
First Department of Medicine, Tokyo Women's Medical University.
Nihon Kokyuki Gakkai Zasshi. 2011 Feb;49(2):103-7.
An 80-year-old man was admitted to our hospital with chest pain. Chest computed tomography (CT) showed masses in both lung fields. The findings from a biopsy specimen of the left chest wall showed radially filamentous microorganisms, therefore a diagnosis of thoracic actinomycosis was made. The specimen from the mass in the right upper lobe obtained by transbronchial lung biopsy (TBLB) did not yield a definitive, and we started administration of penicillin. After 10 weeks the mass and consolidation in left upper lobe improved, but the size of the mass in the right upper lobe had increased. FDG-PET showed high accumulation only in the right lung mass, and TBLB was performed again, with pathological findings of squamous cell carcinoma. In most cases it is very difficult to differentiate pulmonary actinomycosis from lung cancer. Pulmonary actinomycosis with coexisting lung cancer is very rare. If penicillin is ineffective in a patient with actinomycosis, pulmonary actinomycosis with coexisting with lung cancer should be considered.
一名80岁男性因胸痛入院。胸部计算机断层扫描（CT）显示双肺野有肿块。左胸壁活检标本的检查结果显示有放射状丝状微生物，因此诊断为胸段放线菌病。经支气管肺活检（TBLB）获取的右上叶肿块标本未得出明确结果，于是我们开始使用青霉素治疗。10周后，左上叶的肿块和实变有所改善，但右上叶肿块的大小却增大了。氟代脱氧葡萄糖正电子发射断层扫描（FDG-PET）显示仅右肺肿块有高摄取，遂再次进行TBLB，病理结果为鳞状细胞癌。在大多数情况下，很难将肺放线菌病与肺癌区分开来。合并肺癌的肺放线菌病非常罕见。如果放线菌病患者使用青霉素无效，应考虑合并肺癌的肺放线菌病。
