Nonresolving pneumonia.

A 58-year-old man admitted for evaluation of weight loss and dry cough. Initially, he was diagnosed with community-acquired pneumonia. Despite receiving antibiotics, his clinical status deteriorated and was intubated. Fiber optic bronchoscopy revealed a significant amount of mucopurulent secretions. Bronchoalveolar lavage showed marked amount of sulfur granules identified on stain. Microbiology culture was compatible with Actinomyces israelii. Pulmonary actinomycosis is a rare but important and challenging diagnosis to make. It presents with wide spectrum of clinical and radiologic characteristics. Failure to recognize the disease early may result in drastic complications. (C) 2011 Lippincott Williams & Wilkins, Inc.