Conclusion
We present a rare case of advanced endobronchial actinomycosis in a child . We postulate that dental caries were the source of the infection, which led to micro aspiration of the pathogen. We postulate that there was delay in referral and diagnosis due to the SARS-CoV-2 pandemic. . This case highlights the difficulty in diagnosis of rare lung conditions in high incidence settings of tuberculosis, particularly where there is limited access to specialised pulmonology, infectious diseases and microbiology services. The diagnosis in this case was made on BAL. Bronchoscopy can be dangerous when performed on these cases, as there is a risk of severe bleeding and large airway obstruction, as was the case with this patient.