Chronic sinusitis unresponsive to medical therapy: a case of maxillary sinus actinomycosis focusing on computed tomography findings

Actinomycosis of the paranasal sinuses: case report and literature review

Actinomycosis is a chronic granulomatous condition caused by filamentous gram-positive anaerobic bacteria that colonizes the mouth, gastrointestinal tract and urogenital tract. Infection occurs through the mucosal surfaces, often resulting from dental procedures or trauma, primarily affecting the maxillary sinus. We report a case of Actinomyces sinusitis affecting the right maxillary and right ethmoidal sinuses of a 41-year-old woman. The diagnosis was made through a combination of histopathological report and computed tomography scan. The patient underwent endoscopic sinus surgery followed by long-term antibiotics for 6 months and reported improvement of her symptoms.

Actinomyces Acute Rhinosinusitis Complicated by Subperiosteal Abscess in an Immunocompromised 12-Year-Old: Case Report and Literature Review

Objective

To describe a rare case of pediatric actinomycotic rhinosinusitis with orbital subperiosteal abscess and review the current literature to assess methods of diagnosis, treatment modalities, and outcomes with appropriate treatment.

Methods

A case report and a review of the literature.

Results

A 12-year-old patient with Crohn's disease on infliximab presented with rhinosinusitis with orbital subperiosteal abscess formation. Endoscopic sinus surgery was performed and cultures grew actinomyces. A prolonged course of antibiotics was started, resulting in the complete resolution of the infection. In a literature review, all cases of uncomplicated and complicated actinomyces rhinosinusitis managed with appropriate surgery and prolonged antibiotics resulted in a cure. Our case is the first reported in a pediatric patient and the first taking immunosuppressive medication. Overall, only 3 cases of actinomyces rhinosinusitis in immunosuppressed individuals have been reported, each with uncontrolled diabetes and each also responded well to surgery and appropriate antibiotics.

Conclusion

Actinomycosis of the paranasal sinuses poses a diagnostic challenge, with infections varying widely in presentation and extent of disease. A high index of suspicion, appropriate testing, and early aggressive treatment are critical in managing patients with this infection. Our case and prior published studies show that actinomyces rhinosinusitis can be successfully managed with endoscopic sinus surgery, abscess drainage as necessary, and a prolonged course of antibiotics, even in immunocompromised and pediatric populations.

Paranasal sinus actinomycosis treated with a combination of surgery and long-term low-dose macrolide

Actinomycosis is a bacterial infection caused by actinomyces. Although almost 50% of cases are related to the head and neck region, those in the nose and paranasal sinuses (PNS) are rare. Actinomycosis of the PNS is presumed to be typically caused by dental caries, dental manipulation, and maxillofacial trauma, which facilitate the penetration of oral pathogens into the sinus, and should thus be treated by the combination of surgical removal and potent antibiotics for at least two months. The current use of these antibiotics might be redundant, considering the nature of actinomycosis of the PNS, which does not invade the mucosal surface. We herein report a 67-year-old female treated with endoscopic sinus surgery (ESS) and diagnosed with actinomycosis of the PNS by pathological findings. She had no history of dental impairment or treatment. She was given routine perioperative prophylactic antibiotics (cefazolin) during the surgery, followed by low-dose clarithromycin. The mucosa of the PNS normalized without any discharge by three months after the operation. The patient is a valuable example that should prompt reconsideration of the commonly accepted pathogenesis and treatment of actinomycosis of the PNS.

Unilateral Maxillary Sinus Actinomycosis with a Closed Oroantral Fistula

Actinomycosis is a bacterial infection due to Actinomyces israelii, a gram-positive, anaerobic organism that normally affects the cervicofacial region. However, facial injury or trauma (i.e., dental procedures) can allow this bacteria to inhabit other regions. There have been rare reports of actinomycosis of the paranasal sinuses. We present a case of a 50-year-old female who originally presented with a suspected oroantral fistula who subsequently was found to have actinomycosis involving her right maxillary sinus. Additionally, the dental extraction site revealed no connection with the maxillary sinus. We discuss the diagnostic approach and management of this patient as it relates to the limited existing literature.

Actinomycotic Osteomyelitis of Maxilla Presenting as Oroantral Fistula: A Rare Case Report

Actinomycosis is a chronic granulomatous infection caused by Actinomyces species which may involve only soft tissue or bone or the two together. Actinomycotic osteomyelitis of maxilla is relatively rare when compared to mandible. These are normal commensals and become pathogens when they gain entry into tissue layers and bone where they establish and maintain an anaerobic environment with extensive sclerosis and fibrosis. This infection spreads contiguously, frequently ignoring tissue planes and surrounding tissues or organ. The portal of entry may be pulpal, periodontal infection, and so forth which may lead to involvement of adjacent structures as pharynx, larynx, tonsils, and paranasal sinuses and has the propensity to damage extensively. Diagnosis is often delayed and is usually based on histopathology as they are cultured in fewer cases. The chronic clinical course without regional lymphadenopathy may be essential in diagnosis. The management of actinomycotic osteomyelitis is surgical debridement of necrotic tissue combined with antibiotics for 3-6 months. The primary actinomycosis arising within the maxilla with contiguous involvement of paranasal sinus with formation of oroantral fistula is rare. Hence, we present a 50-year-old female patient with chronic sclerosing osteomyelitis of maxilla which presented as oroantral fistula with suppurative and sclerotic features.

Invasive sinonasal actinomycosis: case report and literature review

Actinomycosis is a rare anaerobic bacterial infection typically caused by Actinomyces israelii. Although part of normal flora in the oral cavity, and respiratory and digestive tracts, A israelii can give rise to pathologic infections most commonly reported in the oral cavity from odontogenic causes. We present a rare case of invasive actinomycosis presenting with extensive midface destruction involving the maxilla and paranasal sinuses, with mucosal necrosis mimicking an aggressive neoplasm. The diagnosis is usually reached only after histopathologic analysis showing characteristic sulfur granules with filamentous gram-positive, non-acid-fast bacteria. We review the literature on its epidemiology, clinical presentation, diagnosis, treatment, and prognosis.

Simultaneous actinomycosis with aspergillosis in maxillary sinus

We report a case with review of literature of actinomycosis accompanied with aspergillosis arising in unilateral maxillary sinus, in which it was completely cured after endoscopic sinus surgery and short term antibiotic therapy. To the best of our knowledge, this is the first case report in literature reporting actinomycosis in combination with aspergillosis in the paranasal sinus. Also, we suggest short term antibiotic therapy within one month may be sufficient if the surgical opening of paranasal sinus involved by actinomycosis could be well preserved.

[Actinomycosis of sinus maxillaris--case report]

The authors present the case of primary actinomycosis of maxillary sinus. The frequency of the disease, differential diagnosis and treatment we present.