Opportunistic actinomycosis in pulmonary alveolar proteinosis

Abstract

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.