Pulmonary Actinomycosis Diagnosed via BALF mNGS in a 53-Year-Old Nonsmoking Man With Pneumoconiosis and Penicillin-Induced Thrombocytopenia: A Case Report.
Xin Feng, Lin-Yu Wang, Ni-Jiao Li et al.
✦ AI-curated · Sources linked
Case in brief
A 53-year-old nonsmoking man with pneumoconiosis presented with a month-long history of cough and hemoptysis. Imaging revealed bilateral upper-lung masses and lymphadenopathy, leading to a right upper lobectomy under suspicion of malignancy. Despite negative conventional tests, bronchoalveolar lavage fluid metagenomic next-generation sequencing identified Actinomyces israelii. Treatment with ampicillin/sulbactam improved his condition but caused severe thrombocytopenia, prompting a switch to omadacycline, resulting in clinical recovery and normalization of platelet counts.
What made this case unusual
The case highlights the use of bronchoalveolar lavage fluid metagenomic next-generation sequencing to diagnose pulmonary actinomycosis when conventional methods failed, particularly in a patient with pneumoconiosis.
Diagnostic / clinical pearl
Clinicians should consider metagenomic next-generation sequencing for diagnosing pulmonary infections like actinomycosis, especially when conventional tests yield inconclusive results.
Why it matters
This case underscores the importance of alternative diagnostic methods in complex pulmonary infections and the need for careful management of antibiotic-induced adverse effects.