A 55-year-old guy arrives at the office complaining of malaise and cough for the previous two months. He mentions yellow sputum with intermittent blood streaks. The patient smokes a pack of cigarettes every day and has a history of alcohol use disorder with past binge drinking episodes. The temperature is 37.1 degrees Celsius (98.8 F). Dental caries, gingivitis, and swollen submandibular lymph nodes are seen during the examination. During right lung auscultation, coarse rhonchi are heard. With air bronchograms, a chest CT scan demonstrates an extensive right lung consolidative process. Bronchoscopy is conducted, and the results of a lung biopsy specimen are shown in the image below. Which of the following is the most likely diagnosis?

Question

A 55-year-old guy arrives at the office complaining of malaise and cough for the previous two months. He mentions yellow sputum with intermittent blood streaks. The patient smokes a pack of cigarettes every day and has a history of alcohol use disorder with past binge drinking episodes. The temperature is 37.1 degrees Celsius (98.8 F). Dental caries, gingivitis, and swollen submandibular lymph nodes are seen during the examination. During right lung auscultation, coarse rhonchi are heard. With air bronchograms, a chest CT scan demonstrates an extensive right lung consolidative process. Bronchoscopy is conducted, and the results of a lung biopsy specimen are shown in the image below.  Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

Eductional Objective: Pulmonary actinomycosis is most usually caused by aspiration and can be mistaken for a lung abscess, cancer, or TB. Sulfur granules and filamentous, branching, gram-positive bacteria were discovered under the microscope.

A 55-Year-Old Guy Arrives at the Office Complaining of Malaise