Endobronchial Actinomycosis Secondary to a Tooth Aspiration

A Case of Pulmonary Actinomycosis Associated With Aspiration of Cedar Leaves

The aspiration of foreign bodies may induce various infectious diseases, including actinomycosis, and its association with foreign bodies has been reported. We encountered a patient who developed Actinomyces-induced lung abscess associated with aspiration of cedar leaves. The patient was a 56-year-old Japanese woman who aspirated decorative cedar leaves contained in a lunch box while eating a meal, and coughing and bloody phlegm occurred thereafter. A mass was noted in the right lower lobe of the lung on plain chest computed tomography on the first consultation, and granules of Actinomyces were noted on transbronchial lung biopsy. Long-term antibiotic administration was performed, but no improvement was obtained. Thus, right lower lobectomy was performed. On postoperative pathologic examination, cedar leaves were present in the bronchus, bacterial colonies adhered to these, and there was surrounding inflammatory cell infiltration, mainly involving histiocytes and lymphocytes. This is the first report of Actinomyces associated with aspiration of cedar leaves. When the foreign body cannot be removed, it may be difficult to improve the condition by antibiotic administration alone, and surgery may be necessary.