TY - JOUR T1 - Pulmonary actinomycosis: Successful treatment with oral antibiotics JF - European Respiratory Journal JO - Eur Respir J VL - 42 IS - Suppl 57 SP - P4355 AU - Nicole Skehan AU - David Walter AU - Raja Reddy Y1 - 2013/09/01 UR - http://erj.ersjournals.com/content/42/Suppl_57/P4355.abstract N2 - Endobronchial actinomycosis is a rare but important differential of exophytic endobronchial tumors. We report the case of an 84 year old woman presenting with a 1 year history of productive cough, haemoptysis and weight loss. Computed tomography (CT) revealed complete right upper lobe obstruction with secondary bronchiectasis. Bronchoscopy showed an exophytic tumour. Histology showed filamentous bacteria consistent with actinomycosis. The patient refused intravenous (IV) antibiotics for personal reasons and was commenced on oral doxycycline 200mg daily due to multiple antibiotic allergies. At 3 month follow up there was significant clinical and radiological improvement. Subsequent CT chest showed resolution of the endobronchial lesion with persistence of the distal bronchiectasis.Endobronchial actinomyces is usually caused by aspirated oropharyngeal secretions, hence a predilection for the dependent lobes and rarely upper lobe involvement. Treatment of choice is penicillin G IV followed by oral antibiotics but actinomyces also sensitive to a number of other antibiotics. Traditionally treatment required prolonged courses of IV antibiotics, stemming from an era when disease was advanced at presentation. But recent reports have shown good responses with short courses. A significant number of cases are associated with a foreign body or broncholithiasis; removal is key for successful treatment. A follow up bronchoscopy is important to confirm resolution. Our patient refused, but had a reconstructed CT bronchoscopy which confirmed resolution.Treatment duration should be tailored to the individual, shorter antibiotic courses appear to be adequate in those with low infection burden like endobronchial actinomycosis. ER -