Hemoptizi ile Başvuran İmmünkompetan Bir Erkekte Olası Lophomonas Pnömonisi:Olgu Sunumu

Türkçe

Lophomonas blattarum is a protozoan that typically infects the lower respiratory tract and causes bronchopulmonary infections. Although its clinical manifestations are nonspecific, they may include symptoms such as cough, sputum production, fever, chest discomfort, and respiratory distress. The diagnosis of Lophomonas infection relies on the morphological identification of the parasite in respiratory secretions using light microscopy. Differentiating the parasite from ciliated bronchial epithelial cells is challenging and critically important for accurate diagnosis. In this case report a L.blattarum infection in an immunocompetent adult man was presented. A 46-year-old man admitted to our hospital with the complaints of hemoptysis, exertional dyspnea, fatigue, night sweats and productive cough. Thoracic computed tomography revealed a 2 cm abscess/cyst in the right upper lobe, with adjacent consolidation/ atelectasis and ground-glass opacities. Empirical treatment was initiated with a preliminary diagnosis of pneumonia. Due to persistent hemoptysis, fiberoptic bronchoscopy was performed. Sputum and bronchoalveolar lavage (BAL) fluid samples were collected for acid-fast bacilli testing, culture and direct microscopic examination. Trophozoites morphologically consistent with L.blattarum were observed in the BAL specimen by direct microscopy and Giemsa staining. A polymerase chain reaction analysis was performed to confirm the diagnosis; however, no reliable results specific to the target parasite were obtained. Therefore, based on compatible microscopic findings, a presumptive diagnosis of Lophomonas infection was made and nonspecific antibiotic therapies were discontinued in favor of metronidazole. Following the treatment, the patient experienced dramatic clinical and radiological improvement and was discharged in good health. This case highlights that Lophomonas infection can also occur in immunocompetent individuals and may mimic other bronchopulmonary infections. It underscores the critical role of microscopic examination in diagnosis, while also pointing to the need for standardized molecular diagnostic methods. In clinical practice, the possibility of lophomoniasis should not be ignored in cases that do not respond to empirical antibiotic therapy and every suspected case should be carefully evaluated.