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- Case Report -

A Case of Pulmonary Actinomycosis Which Was Difficult to Clinically Differentiate from Lung Cancer Due to Elevated Serum CEA Levels

Keigo Ozono¹, Masaaki Inoue¹, Satoshi Kuboi², Masamitsu Kido², Ryoichi Nakanishi^1
1Department of Thoracic Surgery, ²Department of Respiratory Medicine, Shin-kokura Hospital, Japan

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Background. Pulmonary actinomycosis is a chronic granulomatous disease caused by Actinomyces israelii, an anaerobic bacterium which is commonly found in the mouth or alimentary tract. It is often difficult to differentiate pulmonary actinomycosis from lung cancer on diagnostic imaging. Case. A 61-year-old woman visited our hospital with a chief complaint of bloody sputum. Chest computed tomography showed a neoplastic lesion with cavities and pleural indentations in the right posterior segment (S²). Bronchial washing and exfoliative cytological findings of bronchoscopic lavage fluid and cells showed class II, respectively. A diagnosis of lung cancer could not be excluded as the patient's serum CEA level was 11.7 ng/ml and she showed a standardizad uptake value (SUV) max of 6.11 on positron-emission tomography. We performed video-assisted thoracoscopic surgery (VATS) of the right upper lobe for diagnosis and treatment and pathologic examination revealed pulmonary actinomycosis. Conclusion. We consider that it may be necessary to perform an invasive surgical procedure such as VATS for curative treatment of pulmonary actinomycosis.
key words: Pulmonary actinomycosis, CEA, PET, Lung cancer

Received: March 4, 2011
Accepted: October 25, 2011

JJLC 51 (7): 809-813, 2011