08/03/2010
Pleural effusion.
California Hospital Medical Center
70-year-old male with progressive shortness of breath. He also has lung cavitary lesion with communication with the pleural space, suspicious for bronchopleural fistula.
Procedure: U/S guided aspiration of pleural effusion.
Micro: Thinprep smear and cell block show aggregations of microorganisms that vary in size from short, diphtheroid forms to long, branching filaments.
Special stains:
Gram stain: partially positive in short, diphtheroid forms.
AFB stain: Negative.
Modified Kinyoun acid-fast stain: Negative
Gomori methenamine silver stain: Positive
Discussion:
Thoracic actinomycosis poses a diagnostic challenge to clinicians not only because it is uncommon and often forgotten, but also because culture of the causative microbes is technically difficult. Actinomycotic infection is uncommon and primary actinomycosis of the lung and chest wall has been less frequently reported. This disease may present as chronic debilitating illness with radiographic manifestation simulating lung tumor, pulmonary infiltrating lesion, or chronic suppuration. The classic microscopic appearance of this Gram-positive bacteria associated with surrounding sulfur granules often forms the basis of diagnosis.
References:
Wong RH, Sihoe AD, Thung KH, Wan IY, Ip MB, Yim AP. Actinomycosis: an often forgotten diagnosis. Asian Cardiovasc Thorac Ann. 2004 Jun;12(2):165-7.
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