A 58-year-old man with cough, weight loss, and lung nodules. See how biopsy findings of ‘sulfur granules’ lead to an unexpected diagnosis.
A 58-year-old man presented to the outpatient pulmonary clinic with a productive cough and a history of weight loss of 10 kg during the preceding 3 months. He was an active smoker and for the preceding 4 years had worked in a factory processing cotton. Computed tomography of the chest and abdomen revealed multiple pulmonary nodules (Panel A) associated with pericardial effusion, pleural effusions in both lungs, and multiple liver lesions. On biopsy of the lung, multiple lesions containing sulfur granules were observed along the bronchial vascular bundle (Panels B and C, with Panel C providing a closeup view of the circled area in Panel B; staining with hematoxylin and eosin). What is the most likely diagnosis?
What is the most likely diagnosis?
Actinomycosis, Infectious Disease, Penicillin, Pulmonary Nodules, Sulfur Granules
