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Opportunistic actinomycosis in pulmonary alveolar proteinosis
  1. Sze Shyang Kho1,2,
  2. Suhashini Ganapaty3,
  3. Noorjehan Omar3,
  4. Shang Ze Tan4,
  5. Mona Zaria Nasarudin1,
  6. Jamalul Azizi Abdul Rahaman1
  1. 1 Department of Pulmonology, Serdang Hospital, Kajang, Selangor, Malaysia
  2. 2 Division of Respiratory Medicine, Sarawak General Hospital, Kuching, Sarawak, Malaysia
  3. 3 Department of Pathology, Serdang Hospital, Kajang, Selangor, Malaysia
  4. 4 Department of Medicine, Hospital Ampang, Ampang, Malaysia
  1. Correspondence to Dr Sze Shyang Kho, Department of Pulmonology, Serdang Hospital, Kajang, Selangor, Malaysia; khosze{at}

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Case report

A 58-year-old woman with major depressive disorder presented with an insidious onset of fever and haemoptysis for a 1-month duration. She was also troubled with chronic cough over the past 2 years. Her weight was stable and there was no family history of malignancy. She was an ex-smoker of 15 pack years. She worked in the textile industry involved in stonewashing of denim fabric in which she had unprotected exposure to silica dust from pumice stones for the past 30 years. On examination, she was febrile with temperature of 37.8°C and heart rate of 109 beats/min. Blood pressure was 154/86 mm Hg with a saturation of 96% on room air. Chest auscultation revealed reduced air entry over the right upper zone anteriorly. There was no cervical lymphadenopathy, and her fingers were not clubbed.

A plain chest radiograph revealed right upper lobe consolidation with patchy ground glass opacity over the left hemithorax (figure 1). Blood investigations were normal, and the initial workup was not suggestive of any acquired immunodeficiency state. CT thorax revealed necrotic consolidative changes in the anterior segment of right upper lobe with multiple air pockets. Interestingly, patchy ground glass opacities were also seen interspersed with smooth thickening of interlobular and intralobular septa in all lobes, giving rise to a crazy-paving pattern …

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  • Contributors SSK initiated the idea for manuscript submission and prepared the final copy of the manuscript. SSK and SZT acquired the clinical data. SG and NO provided the pathological analysis. SSK, SZT, MZN were involved in the care of the patient. JAAR supervised the whole management process. All authors have read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.