Fistula bronco-pericárdica en una mujer joven por actinomicosis pulmonar complicada

A 26-year-old woman admitted to the dehydrated emergency department, in poor general conditions, with a high-expenditure diarrhea associated with abdominal pain. She reports a history of asthma in treatment with corticosteroid therapy, bacterial pneumonia six months ago for which she received treatment for three months, with the presence of a pulmonary nodule without a determined etiology. During the hospitalization it presents progressive deterioration with signs of systemic inflammation and dies on the third day of hospitalization. In the macroscopic study, the pericardium adhering to the right lung was observed, which, when cut, produces purulent fluid, approximately 500 cc (Figure 1A). In the middle lobe of the right lung, pulmonary abscess and fistula communicating with the pericardium are recognized (Figure 1B). The microscopic examination reveals in the lung parenchyma and in the bronchial light filamentous branch of Actinomyces spp, associated with acute and chronic infiltrate in the periphery (figure 2).