Case Report: Fatal massive hemoptysis secondary to pulmonary actinomycosis: a diagnostic and therapeutic challenge in a multidisciplinary approach
Abstract
BACKGROUND: Actinomyces infections tend to involve the head and neck, while lung infections are relatively rare, and fatal hemoptysis due to pulmonary actinomycosis is even rarer.
CASE PRESENTATION: A 74-year-old male patient who presented with a cough with intermittent hemoptysis for 17 months was admitted to the hospital for the fourth time on June 24, 2024. At the first visit (15 months ago), a computed tomography (CT) scan of the chest revealed a high-density shadow in the right middle bronchus (suggesting a foreign body to be drained) and an infected lesion in the lower lobe of the right lung. Hemoptysis was temporarily relieved after bronchoscopic removal of the foreign body and anti-infective treatment. Four months later, the patient was readmitted to the hospital due to a recurrence of hemoptysis. CT showed a lesion in the right lower lobe of the lung with cavitation, and bronchoscopy showed no abnormality. The pathology of percutaneous lung puncture biopsy suggested acute and chronic inflammation, and the patient was discharged under oral treatment with moxifloxacin. Four months later, the patient was admitted to the hospital for the third time because the hemoptysis volume had increased to 50 ml/day. Digital subtraction angiography-guided bronchial artery embolization was performed, and hemoptysis was controlled after the operation. Six months later, the patient was re-admitted to the hospital because of sudden hemoptysis as an emergency. Various medications were…
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