Pulmonary actinomycosis presenting with prolonged fever and massive hemoptysis: a case report.

We present a rare case of pulmonary actinomycosis complicated with massive hemoptysis. The patient was a 41-year-old male farmer, who had experienced prolonged fever and off-and-on blood streaked sputum for 2 years. He was admitted to our hospital because of 3 days of massive hemoptysis. He had no underlying medical illnesses, but was a heavy smoker and an alcoholic. The chest radiograph revealed patchy alveolar infiltration of the right upper lobe, mimicing tuberculosis. Massive hemoptysis was not controlled using conservative treatment and anti-tuberculous drugs. Emergency right upper lobe lobectomy was needed to stop the bleeding. Histopathologic examination demonstrated aggregates of filamentous gram-positive organisms in characteristic "sulfur granules", indicating actinomycosis. The fever subsided after intravenous augmentin was given, followed by 6 months of oral amoxicillin. The patient is doing well and has had no recurrent hemoptysis.

Bronchial adenoma presenting with chronic asthma and obstructive pneumonia: a case report.

A rare case of primary pulmonary neoplasm is reported. The patient was a 38-year-old woman presenting with obstructive pneumonia. Fiberoptic bronchoscopy revealed an endobronchial mass obstructing the left main bronchus: a reddish polypoid mass which bled on contract that was suggestive of bronchial adenoma. The patient also had a long-standing history of bronchial asthma and hemoptysis and the delay in establishing the eventured diagnosis was caused by the minor symptoms mimicking those of asthma. A persistent restrictive lung and the presentation of obstructive pneumonia were important clues which warranted further investigation by computed tomography (CT) scan and bronchoscopy. The patient underwent rigid bronchoscopy with CO2-laser ablation under general anesthesia. Histopathology confirmed a bronchial adenoma. The clinical response was excellent. Bronchial adenoma should be considered in young patients presenting with asthma, hemoptysis and obstructive pneumonia. Bronchoscopic CO2-laser ablation is an effective treatment and provides an alternative to aggressive thoracotomy.