Khatib Sohaib, Al-Shyoukh Ahmad, Abdalla Khalid, Jaber Fouad S, Salzman Gary
Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA.
Pulmonary and Critical Care Medicine, Tulane University School of Medicine, New Orleans, USA.
Cureus. 2022 Jan 11;14(1):e21133. doi: 10.7759/cureus.21133. eCollection 2022 Jan.
Pulmonary actinomycosis is a common clinical infection caused by species. Although its treatment is very effective with Intravenous (IV) antibiotics, its diagnosis is challenging and easily missed. Organizing Pneumonia (OP) can be cryptogenic or secondary to different clinical diseases. Herein, we discuss a case of acute hypoxemic respiratory failure that was found to be due to OP, secondary to pulmonary actinomycosis, with a brief review of the literature. A 64-year-old male presented with acute hypoxemic respiratory failure two days after undergoing elective right total hip arthroplasty. Chest imaging with CT scan showed symmetric bilateral ground-glass opacities most pronounced within the upper lung lobes. The patient was treated initially with IV diuresis, steroids, and broad-spectrum antibiotics. However, his clinical status continued to worsen and his chest imaging showed worsening lung opacities. Video-assisted thoracoscopic lung biopsy (VATS) was done, and pathology results showed features of organizing pneumonia. Tissue culture confirmed species. The patient had clinical improvement after treatment with IV methylprednisolone and IV penicillin G. Pulmonary actinomycosis is very rarely associated with OP but this bacterial infection should always be in the differential diagnosis when OP is confirmed as the treatment is effective with IV antibiotics.
肺放线菌病是由放线菌属引起的一种常见临床感染。尽管静脉注射抗生素对其治疗非常有效，但其诊断具有挑战性且容易漏诊。机化性肺炎（OP）可为隐源性或继发于不同的临床疾病。在此，我们讨论一例急性低氧性呼吸衰竭病例，该病例被发现是由继发于肺放线菌病的OP所致，并对相关文献进行简要回顾。一名64岁男性在接受择期右全髋关节置换术后两天出现急性低氧性呼吸衰竭。胸部CT扫描显示双侧对称性磨玻璃影，在上肺叶最为明显。患者最初接受静脉利尿、类固醇和广谱抗生素治疗。然而，他的临床状况持续恶化，胸部影像学显示肺部阴影加重。进行了电视辅助胸腔镜肺活检（VATS），病理结果显示有机化性肺炎的特征。组织培养确诊为放线菌属。患者在接受静脉注射甲泼尼龙和静脉注射青霉素G治疗后临床症状改善。肺放线菌病很少与OP相关，但当确诊为OP时，这种细菌感染应始终列入鉴别诊断，因为静脉注射抗生素治疗有效。
