Endobronchial Actinomycosis Associated with a Foreign Body and Presenting as Asthma

Actinomycosis as the cause of an endobronchial mass is rare, and its association with a foreign body has only been described in a few reports. We herein report a 57-year-old female who was diagnosed as having asthma with intractable wheezing for about four years. Her symptoms were poorly controlled by oral prednisolone, theophylline and β2-agonist. Physical examination revealed bilateral wheezing on chest auscultation with an increased wheeze intensity in the right lower lung field. Chest radiography was normal. Because of the uneven wheeze, bronchoscopy was arranged to rule out an endobronchial lesion. A yellowish hard mass was noted in the right intermediate bronchus obstructing about 70 % of the lumen. The surrounding mucosa was hyperemic and edematous. Histologic examination showed colonies of filamentous bacteria forming sulfur granules consistent with actinomycosis. The patient was treated with intravenous penicillin, 3-million units every 6 hours for two weeks, followed by oral amoxicillin 250 mg every 6 hours for one year. Repeated bronchoscopy showed improvement in the mucosal inflammation, but the endobronchial tumor had only partially regressed. A thoracotomy with bronchotomy was performed, and four pieces of a foreign body (animal bone tissue) were removed. After operation, her asthma symptoms resolved without the use of a bronchodilator. Aspiration of a foreign body with chronic inflammation of the airways due to actinomycosis may have contributed to the intractable bronchospasm in this case. Since actinomycosis can be treated successfully with antibiotics alone, actinomycosis associated with an endobronchial lesion should be suspected in patients who respond poorly to antibiotic treatment.