Nonresolving pneumonia.

A 58-year-old man admitted for evaluation of weight loss and dry cough. Initially, he was diagnosed with community-acquired pneumonia. Despite receiving antibiotics, his clinical status deteriorated and was intubated. Fiber optic bronchoscopy revealed a significant amount of mucopurulent secretions. Bronchoalveolar lavage showed marked amount of sulfur granules identified on stain. Microbiology culture was compatible with Actinomyces israelii. Pulmonary actinomycosis is a rare but important and challenging diagnosis to make. It presents with wide spectrum of clinical and radiologic characteristics. Failure to recognize the disease early may result in drastic complications.