Endobronchial actinomycosis: successful treatment with oral antibiotics.

This is a case report of an 84-year-old lady who presented with haemoptysis, weight loss and a right hilar mass on chest radiograph. CT scan of the chest revealed complete proximal occlusion of the right upper lobe from an endobronchial lesion consistent with a tumour. The patient was initially reluctant to undergo fibreoptic bronchoscopy as she was deemed to be unsuitable for any curative treatment of lung carcinoma. Bronchoscopy showed an exophytic necrotic tumour within the right upper lobe. Biopsies showed many bacterial colonies consistent with actinomyces and a diagnosis of endobronchial actinomycosis was made. Owing to multiple antibiotic allergies and patient refusal to have intravenous antibiotics, she was started on a course of doxycycline 200 mg once daily. There was near complete improvement in symptoms and radiographic appearances by the end of 4 months. This case highlights the importance of confirmatory diagnosis in the elderly as curable conditions are otherwise missed.