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Background <p>Pulmonary actinomycosis (PA) is a rare and diagnostically challenging infection because its clinical and radiological manifestations are nonspecific and often mimic malignancy and other chronic pulmonary diseases. This study aimed to evaluate the clinical, radiological, diagnostic, and treatment characteristics of patients with PA and to assess real-world treatment outcomes.</p> Methods <p>We retrospectively reviewed the medical records of adult patients diagnosed with histopathologically confirmed PA between January 2013 and December 2023 at a tertiary referral center.</p> Results <p>A total of 69 patients were included. The median age was 56 years (IQR<sub>25–75</sub>: 44–60), and 66.7% were male. Overall, 78.3% of patients had at least one comorbidity, most commonly structural lung diseases. The most frequent presenting symptoms were cough (43.5%) and hemoptysis (36.2%). Thoracic CT most commonly demonstrated consolidation, bronchiectasis, mediastinal lymphadenopathy, cavitary lesions, and pulmonary nodules. PET-CT frequently showed high FDG uptake, with a mean SUVmax of 9.07 ± 4.40, thereby limiting its specificity in differentiating PA from malignancy. Bronchoscopic procedures represented the most common diagnostic method. The median interval from initial presentation to treatment initiation was 82 days (IQR<sub>25–75</sub>: 42–164). The median duration of oral antibiotic treatment was 105 days (IQR<sub>25–75</sub>: 57–180). Compared with medically treated patients, those undergoing surgical intervention more frequently presented with cavitary lesions and hemoptysis and tended to have a longer interval before treatment initiation. During follow-up, no deaths were directly attributable to PA, and no recurrence was observed among evaluable patients.</p> Conclusions <p>PA remains a major diagnostic challenge because of its heterogeneous clinical and radiological presentation. PET-CT appears to provide limited additional diagnostic value because of the high FDG uptake frequently observed in PA lesions. Management strategies should be individualized according to clinical presentation, radiological findings, comorbidities, and the potential need for surgical intervention. Larger multicenter studies are needed to better define optimal diagnostic and treatment approaches for this rare disease.</p>

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Clinical characteristics, diagnostic challenges, and management of pulmonary actinomycosis: a 10-year retrospective cohort study

  • 期刊论文

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  • 发表日期：

    2026年7月31日

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  • Şule Gül,
  • Nihan Kurt Gürer,
  • Derya Hırçın Cenger,
  • Esra Çörekli Çölgecen,
  • Mehmet Atilla Uysal

摘要

Background

Pulmonary actinomycosis (PA) is a rare and diagnostically challenging infection because its clinical and radiological manifestations are nonspecific and often mimic malignancy and other chronic pulmonary diseases. This study aimed to evaluate the clinical, radiological, diagnostic, and treatment characteristics of patients with PA and to assess real-world treatment outcomes.

Methods

We retrospectively reviewed the medical records of adult patients diagnosed with histopathologically confirmed PA between January 2013 and December 2023 at a tertiary referral center.

Results

A total of 69 patients were included. The median age was 56 years (IQR25–75: 44–60), and 66.7% were male. Overall, 78.3% of patients had at least one comorbidity, most commonly structural lung diseases. The most frequent presenting symptoms were cough (43.5%) and hemoptysis (36.2%). Thoracic CT most commonly demonstrated consolidation, bronchiectasis, mediastinal lymphadenopathy, cavitary lesions, and pulmonary nodules. PET-CT frequently showed high FDG uptake, with a mean SUVmax of 9.07 ± 4.40, thereby limiting its specificity in differentiating PA from malignancy. Bronchoscopic procedures represented the most common diagnostic method. The median interval from initial presentation to treatment initiation was 82 days (IQR25–75: 42–164). The median duration of oral antibiotic treatment was 105 days (IQR25–75: 57–180). Compared with medically treated patients, those undergoing surgical intervention more frequently presented with cavitary lesions and hemoptysis and tended to have a longer interval before treatment initiation. During follow-up, no deaths were directly attributable to PA, and no recurrence was observed among evaluable patients.

Conclusions

PA remains a major diagnostic challenge because of its heterogeneous clinical and radiological presentation. PET-CT appears to provide limited additional diagnostic value because of the high FDG uptake frequently observed in PA lesions. Management strategies should be individualized according to clinical presentation, radiological findings, comorbidities, and the potential need for surgical intervention. Larger multicenter studies are needed to better define optimal diagnostic and treatment approaches for this rare disease.