Endobronchial mucosal nodules and actinomycosis in a child with activated phosphatidylinositol 3-kinase delta syndrome (APDS)

A 5-year-old girl had poor growth and unresolving pneumonia. There was persistent collapse-consolidation of the right middle lobe. CT thorax revealed bilateral bronchial wall thickening and dilatation. Bronchoscopy showed numerous endobronchial mucosal nodules, consisting of dense lymphoid infiltrates. Bacterial culture of the nodule biopsy suggested endobronchial actinomycosis. She had T-cell lymphopenia. Genetic test confirmed the diagnosis of activated phosphatidylinositol 3-kinase delta syndrome (APDS), an immunodeficiency condition.