Recurrent Life Threatening Massive Hemoptysis as a Presentation of Pulmonary Actinomycosis

Actinomycosis is a rare and slowly progressive infectious disease with mild symptoms such as low-grade fever, cough, chest pain and minor hemoptysis. We report an 81-year-old woman who was admitted to our intensive care unit with presentation of massive hemoptysis associated with hypotension, bradycardia and respiratory failure. The initial diagnosis was necrotizing pneumonia using chest X-ray and chest computed tomography. Another two episodes of life threatening massive hemoptysis with hemodynamic compromise occurred during treatment with antibiotics. Pulmonary angiography with embolization was attempted to stop the bleeding, however, it failed. Surgical intervention was performed due to uncontrolled recurrent life-threatening massive hemoptysis. Pulmonary actinomycosis was diagnosed during histopathology examination following unilateral pneumonectomy and bronchoplasty. The patient was successfully weaned from mechanical ventilator after surgery and was treated with intravenous Penicillin-G for 3 weeks after surgery. This patient was discharged without complications. Thus, recurrent life threatening massive hemoptysis should be considered as a presentation of pulmonary actinomycosis and surgical intervention may be necessary in selected cases. (Chang Gung Med J 2006;29(4 Suppl):66-70)