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Old 10-17-2012
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Lungs Homeless alcoholic and lung mass

A homeless man who is an alcoholic is brought to the emergency department after being found unconscious by the side of the road. Films taken on arrival show some old trauma to the jaw. X-ray of the chest and CT of the chest reveal a mass lesion in the right lower lobe with spiculation, which appears to extend into the pleural space and involve an adjacent rib. A biopsy specimen of the mass-like lesion is shown in the image. Histologic specimens of bronchial lavage fluid after biopsy contain numerous hyphae but no malignant cells. What should be included in the treatment regimen for this man's condition?

A amphotericin B
B ciprofloxacin
C fluconazole
D INH
E penicillin G

Homeless alcoholic and lung mass-biopsy.jpg
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Old 10-17-2012
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A. Amphotericin B.

Because of the presence of hyphae.
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Old 10-17-2012
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A amphotericin B
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Old 10-17-2012
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A amphotericin B????

its systemic infection and have hyphae and spiculation. My best guess is coccidioidomycosis
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Old 10-17-2012
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Aspergillus fumigatus can do cause lung cavity
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Old 10-17-2012
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a) amphotericin B
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Old 10-18-2012
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The correct answer is E. This man likely has actinomycosis from infection with Actinomyces israelii, a gram-positive anaerobic bacterium with a branching filamentous appearance. The image shows what is known as a "sulfur granule" formed by a colony of Actinomyces filaments solidified with tissue exudates. The bacteria are generally normal inhabitants of the oral cavity and are found in dental caries. Poor oral hygiene coupled with trauma increases the risk of aspiration of the organism leading to infection. Infections with Actinomyces tend to be chronic and extend through multiple tissue planes. Actinomyces species appear to be susceptible to a wide range of β-lactam agents, which are regarded as agents of first choice in treatment.

Answer A is incorrect. Amphotericin B is an antifungal agent believed to interact with membrane sterols to produce an aggregate that forms a transmembrane channel. It would not be appropriate treatment of actinomycosis.

Answer B is incorrect. Ciprofloxacin is a fluoroquinolone drug and generally has little effect on Actinomyces. β-Lactam agents are first-line treatment.

Answer C is incorrect. Although Actinomyces exhibit some features typical of fungus, such as branching mycelia formation, they are gram-positive bacteria. They lack nuclear membranes and mitochondria, and have cell walls characteristic of bacteria. In addition, they reproduce by bacterial fission rather than sporogenic or filamentous budding. Fluconazole is an antifungal agent that inhibits the enzyme 14 α-demethylase, preventing the conversion of lanosterol to ergosterol. It would not be appropriate treatment for a bacterial infection.

Answer D is incorrect. Isoniazid is a first-line medication used in the prevention and treatment of tuberculosis, along with rifampicin, pyrazinamide, and ethambutol. The image shows a sulfur granule, not a caseating granuloma, bordered by giant multinucleated cells.

what i dont see is the sulfur granules
+ the word hyphae is very misleading

had the same mistake (amphotericin B)
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