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2018

ANUÁRIO DO HOSPITAL DONA ESTEFÂNIA
REPOSITÓRIO MÉDICO CIENTÍFICO

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ACTINOMYCOSIS IN CHILDREN WHEN COMMNON SYMPTOMS LEAD TO AN UNCOMMON DISEASE

Joana Branco1; Guilherme Lourenço1; Oliveira Santos2; João Neves1; Flora Candeias1 Maria João Brito1

1 - InfectiousDiseasesUnit,Hospital Dona Estefânia, CHLC-EPE, Lisbon, Portugal
2 - PneumologyUnit, Hospital Dona Estefânia, CHLC-EPE, Lisbon, Portugal

- 35th anual meeting of the European Society for Paediatric Infectious Diseases, ESPID, Madrid, Spain, may 23-27, 2017

Resumo:
Background: Actinomyces organisms are part of the endogenous oral flora in humans and rarely cause disease in children. Lung involvement is uncommon and may mimic tuberculosis or neoplastic disorders. Pulmonary actinomycosis should be considered in the differential diagnosis of persistent lung infiltration.
Case Report: We present the case of a 5-year-old girl, with a previous diagnosis of microcytic anemia without investigated etiology, who presented with productive cough and episodes of nonmassive hemoptysis. Chest radiograph revealed a heterogeneous hypotransparency of the right upper lobe. Pneumonia was assumed and her assistant physician empirically treated her with azithromycin. Cough persisted and seven months later she had another episode of hemoptysis. Lung sounds were diminished in the right apex and she had developed digital clubbing. She remained apyretic. Chest radiograph showed homogeneous hypotransparency of right upper and middle lobes and CT showed consolidation of these two segments with images of bronchiectasis. The bronchofibroscopy revealed an epithelized mass in right upper lobe bronchus. Tuberculosis and fungal infection were excluded.  Cultural examination of bronchoalveolar lavage was negative but histologic sample showed numerous sulfur granules, characteristic of Actinomyces. Immunodeficiency disorder was excluded and a few dental cavities were observed. She started treatment with penicillin and clindamycin for four weeks and after eight months of oral treatment with amoxicillin there was significant clinical and radiologic improvement, eschewing the need for surgery.
Comments: This case demonstrates that, even when there is extensive disease, medical treatment with antibiotics can be effective thus avoiding a highly complex surgery and retaining lung capacity. Hemoptysis is a rare symptom, and digital clubbing has not been described before. As is common in children, no risk factors were identified.

Palavras Chave: Bronchofibroscopy; Paediatry; Pulmonaryactinomycosis