Scalp actinomycosis mimicking soft tissue mass

An intriguing case of scalp actinomycosis with brain and eye involvement: successful treatment with ceftriaxone

We present the case of a heathy young male farmer presenting with multiple discharging sinuses over the scalp. Brain imaging suggested the involvement of the brain and ipsilateral eye. Histopathology confirmed the diagnosis of actinomycosis. The patient was successfully treated with ceftriaxone.

Actinomycosis of the Lower Lip: Report of a Case

Actinomycosis is usually a chronic infectious disease caused by Actinomyces species, which are anaerobic Gram-positive bacteria that normally colonize the human oral cavity and digestive and urogenital tracts. Although this lesion often occurs on soft tissue around the mandible, cases localized in the lip are very uncommon. We encountered a patient with actinomycosis in the lower lip. A 76-year-old woman with a 5-mm submucosal nodule of the lower lip was referred to our hospital from a dental clinic. The clinical diagnosis was a benign submucosal tumor. Total excision and histological examination were conducted. No oral antibiotic therapy was prescribed. The histological diagnosis was actinomycosis. The postoperative course was uneventful with no signs of recurrence during the 6 months after surgery.

Viral, bacterial, and fungal infections of the oral mucosa: Types, incidence, predisposing factors, diagnostic algorithms, and management

For millions of years, microbiota residing within us, including those in the oral cavity, coexisted in a harmonious symbiotic fashion that provided a quintessential foundation for human health. It is now clear that disruption of such a healthy relationship leading to microbial dysbiosis causes a wide array of infections, ranging from localized, mild, superficial infections to deep, disseminated life-threatening diseases. With recent advances in research, diagnostics, and improved surveillance we are witnessing an array of emerging and re-emerging oral infections and orofacial manifestations of systemic infections. Orofacial infections may cause significant discomfort to the patients and unnecessary economic burden. Thus, the early recognition of such infections is paramount for holistic patient management, and oral clinicians have a critical role in recognizing, diagnosing, managing, and preventing either new or old orofacial infections. This paper aims to provide an update on current understanding of well-established and emerging viral, bacterial, and fungal infections manifesting in the human oral cavity.

Cervicofacial Primary Cutaneous Actinomycosis: Surgical Treatment for Complete Remission of the Disease

Actinomycosis, an infectious bacterial disease caused by Actinomyces species, is very rare and is characterized by contiguous spreading, subacute to chronic granulomatous inflammation and the formation of multiple abscesses and sinus tracts that may discharge sulfur granules. Actinomycosis that presents on the skin without endogenous origin is called primary cutaneous actinomycosis, and the occurrence and treatment of primary cutaneous actinomycosis is rarely reported. This report describes the treatment of primary cervicofacial actinomycosis with a literature review, and emphasizes the importance of surgical option for complete remission of the disease.

Scalp actinomycosis presenting as soft tissue tumour: A case report with literature review

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Cutaneous actinomycosis presenting as tumoriform mass is rare.

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Histopathological confirmation is mandatory with visualization of sulfur granules which is seen only in 25% cases and can be missed in small biopsy specimen.

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Management of a classical case of cutaneous actinomycosis is high dose IV antibiotics for 4–6 weeks followed by oral penicillin or amoxycillin for 6–12 months.

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Surgical resection is a useful adjuvant therapy specially in large, disfiguring masses not responding to treatment and excisional biopsy is helpful in establishing histopathological confirmation.

Introduction

Actinomycosis is a rare subacute or chronic bacterial infection caused by Gram positive, anaerobic or microaerophilic bacilli. It is characterized by suppuration, abscess formation, tissue fibrosis, draining sinuses & rarely as a soft tissue mass mimicking a tumor.

Case report

A 16 year old boy sustained a trauma over right forehead & wound after which patient presented with swelling over right forehead which was excised and was histopathologically reported as angiomatous lesion. Patient presented with recurrent swelling with ulceration over the same site. CT scan showed soft tissue mass with periosteal reaction of right frontal bone. Wide local excision with removal of periosteum was carried out. Raw area was covered with rotational scalp flap. Histopathology of the excised specimen showed features of actinomycosis.

Discussion

Cutaneous actinomycosis presenting as pseudocarcinomatous or sarcomatous mass is rare. Trauma is a common preceding event which was observed in present case. Histopathological confirmation is mandatory with visualization of sulfur granules. It is managed by high dose IV antibiotics. Surgical resection is a useful adjuvant therapy specially in large, disfiguring masses not responding to medical treatment and where excisional biopsy is helpful in establishing the diagnosis surgical excision alone is not curative, post operative long term antibiotics are adjuvant therapy to avoid recurrence.

Conclusion

Actinomycosis of scalp skin is a rare entity and tumor like presentation is still uncommon. Lesions not resolving with routine antibiotics therapy should be suspected clinically as actinomycosis and treated with high dose antibiotics as histopathology from small biopsy is unreliable.

Actinomycosis: etiology, clinical features, diagnosis, treatment, and management

Actinomycosis is a rare chronic disease caused by Actinomyces spp., anaerobic Gram-positive bacteria that normally colonize the human mouth and digestive and genital tracts. Physicians must be aware of typical clinical presentations (such as cervicofacial actinomycosis following dental focus of infection, pelvic actinomycosis in women with an intrauterine device, and pulmonary actinomycosis in smokers with poor dental hygiene), but also that actinomycosis may mimic the malignancy process in various anatomical sites. Bacterial cultures and pathology are the cornerstone of diagnosis, but particular conditions are required in order to get the correct diagnosis. Prolonged bacterial cultures in anaerobic conditions are necessary to identify the bacterium and typical microscopic findings include necrosis with yellowish sulfur granules and filamentous Gram-positive fungal-like pathogens. Patients with actinomycosis require prolonged (6- to 12-month) high doses (to facilitate the drug penetration in abscess and in infected tissues) of penicillin G or amoxicillin, but the duration of antimicrobial therapy could probably be shortened to 3 months in patients in whom optimal surgical resection of infected tissues has been performed. Preventive measures, such as reduction of alcohol abuse and improvement of dental hygiene, may limit occurrence of pulmonary, cervicofacial, and central nervous system actinomycosis. In women, intrauterine devices must be changed every 5 years in order to limit the occurrence of pelvic actinomycosis.

Dormant primary cutaneous actinomycosis: Acute exacerbation after 16 years

Actinomycosis of head and neck are secondary to a nidus in the oral cavity and the aero-digestive tract. Primary actinomycosis without such predisposition is mostly due to trauma. We are presenting a case of this rare variant involving the forehead. The patient had a swelling over the forehead after a windscreen injury, which was asymptomatic for 17 years. However, 1 year ago, there was a repeat blunt trauma on the same site, but there was no breach of skin. Following this, the swelling became tender and started increasing in size. There was no response to a course of antibiotic and the patient had no concomitant history of any systemic illness. The swelling was excised and the biopsy revealed actinomycosis. This presentation of primary actinomycosis after such a long dormancy has never been reported before. This is yet another unusual presentation of actinomycosis, which is notoriously misdiagnosed owing to its rarity and numerous differential diagnoses.

Facial actinomycosis mimicking a desmoid tumour: case report

Actinomycosis is a chronic, suppurative, granulomatous, fibrosing infection that usually occurs in the cervicofacial region. Actinomyces israelii is the most common organism, with sporadic cases being caused by A. odontolyticus. Even though actinomyces are part of the normal oral flora, infections are rare; rarer still is actinomycotic infection of the facial skin. We describe a case of actinomycosis of the skin of the chin, which histologically mimicked a desmoid tumour.