Pulmonary actinomycosis in a patient with HIV infection

Pulmonary actinomycosis is a rare clinical entity. It may arise primarily from aspiration of infected oropharyngeal material or secondarily from contiguous spread of cervicofacial or abdominal infection. We report the case of an HIV-seropositive patient with a two-week history of fever, a productive cough, and pleuritic chest pain. Chest x-ray revealed bilateral patchy alveolar infiltrates. Histological examination of transbronchial biopsy specimens revealed acute inflammation and granules with radiating gram-positive filaments with clubbed ends consistent with actinomycosis. The patient responded to intravenous penicillin and is currently well on long-term enteral antibiotic therapy.