Description
A 65 year-old man with diabetes presented with a brief febrile illness, extreme debility and respiratory distress. X-ray chest showed a right lower lobe consolidation. A clinical diagnosis of severe community-acquired pneumonia was made for which he required antibiotics, non-invasive ventilatory support and admission to intensive care for a week. Nasopharyngeal swab was positive for influenza A by real-time PCR. The patient made apparent clinical recovery but a persisting right lower zone infiltrate. At follow-up as an outpatient 2 weeks later, he was stable haemodynamically but continued to have low-grade fever, mild hypoxia and a weight loss of 14 kg since illness onset. He was edentulous but had good oral hygiene. Chest X-ray (figure 1) and CT showed dense consolidation in the right lower lobe. Bronchoalveolar lavage showed non-acid fast, Gram positive, branching, filamentous bacteria, identified as actinomycetes in culture on blood agar (figure 2), while...
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