Two unusual presentations of cervicofacial actinomycosis and review of the literature

Cervicofacial actinomycosis is the most common clinical form of actinomycosis. This bacterial infection is rare. Diagnosis is difficult, often it is definitive only after surgical excision of the cervicofacial mass. Personal experience is reported concerning two cases of cervicoactinomycosis. Diagnosis, in both cases, has been based on histological findings, not on clinical symptoms. A review of the literature shows that mainly males are affected by this condition and, in fact, both patients described here are males. Symptoms of acute infection were absent. Both patients denied any history of oromaxillofacial trauma or recent dental extraction or oral manipulations. Imaging techniques--ultrasonography and computerized tomography--were not effective in making the diagnosis, in either of these patients. Furthermore, fine needle aspiration cytology did not provide a definitive diagnosis. Both patients underwent surgical excision of the mass. Penicillin was the drug of choice in post-operative long-term treatment (one month). In one of the two men, intravenous steroids were administered. As in several reports in the literature, the definitive diagnosis was histological and not clinical.

Dual pathology: cervicofacial actinomycosis and nicorandil-induced oral ulceration

INTRODUCTION

Oral ulceration has many causes and is a common presenting symptom in otolaryngology.

CASE REPORT

This article presents an unusual case of dual pathology oral ulceration in an elderly patient. Oral malignancy was initially suspected, but the history, examination and investigation showed that the oral ulceration was caused by actinomycosis infection and by nicorandil use.

DISCUSSION

Cervicofacial acinomycosis is a rare, suppurative bacterial disease in which abscesses can form in the tissues and break through the skin, creating pus-discharging lesions. Nicorandil is a potassium channel blocker used in the treatment of ischaemic heart disease. It has been recently recognised as a cause of persistent ulcerative stomatitis.

CONCLUSION

This case highlights the importance of a high index of suspicion for unusual and reversible causes of oral ulceration, and of dual pathology as a cause. Such vigilance enables early recognition and treatment of potentially reversible conditions.

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

Actinomycosis of the paranasal sinuses is a rare occurrence and its clinical presentation does not suggest a specific diagnosis. Therefore, actinomycosis should be included in the differential diagnosis of neoplasms and granulomatous lesions of the head and neck region. However, the differentiation from a malignant neoplasm is not easy because the radiological findings are frequently similar and positive cultures are difficult to obtain. This report highlights the clinical progress of paranasal actinomycosis associated with some computed tomography findings that can be extremely helpful in the correct diagnosis. The characteristics of the disease are described and the relevant literature is discussed.

[Cervicofacial actinomycosis]

Actinomycosis is an infectious disease that appears throught the world, in cattle and human beings. It is a chronic granulomatous and suppurative lesion, usually affecting the cervicofacial area. Definitive diagnosis, by culture or biopsy, is not always possible, so the clinician must suspect it by its clinical presentation. It is the purpose of this article to present the patients diagnosed and treated in our Department during the last 5 years, and to review the ideal therapy.

[Simultaneous occurrence of cervicofacial an pleuropulmonary actinomycosis]

Successful treatment of rapidly spread cervicofacial and pleuropulmonary actinomycosis case is reported. Significant law destruction and pathological fractures were observed as well.

Actinomycosis of the vallecula: report of a case and review of the literature

A rare case of actinomycosis presenting primarily as a mass in the vallecula is described. The patient was a healthy, 65-year-old Saudi, lady who was not immunocompromised and had no other primary pathology in the oral cavity. The clinical presentation and management of the case are discussed and the relevant literature reviewed.

Cranio-facial actinomycosis

In the National Neurosurgical Centre in the Sultanate of Oman, four patients with cranio-facial actinomycosis were seen over a 5-year period. All patients had osteomyelitis and intracranial granulomata and the diagnosis was confirmed with histopathology. In two cases the organisms were cultured. In three patients the cranial spread was by contiguity from the scalp and face while one case had the extradural granuloma following a dental extraction. With medication there was gross reduction of proptosis and intracranial lesion in one patient and in two there was marked reduction in the size of the intracranial lesion as seen on serial computerized tomographic scanning of the head (CT head). Three patients are now asymptomatic and are being followed up while one expired with subarachnoid haemorrhage. Although eradication of the disease is difficult, with adequate medication and appropriate surgical intervention, three of these patients continue to remain relatively symptom-free for long periods of time.

Actinomycosis: CT findings in six patients

Actinomycosis is an uncommon disease with clinical and radiographic findings that overlap those of other inflammatory and neoplastic conditions. A retrospective review of CT scans in six proved cases revealed a spectrum of findings, including soft-tissue mass with various degrees of infiltration and abscess formation. Administration of IV contrast material was helpful in defining the loculations of the abscess in two cases. Areas of involvement included the neck (two cases), liver (one case), abdominal wall (one case), thorax (one case) and kidney and retroperitoneum (one case). CT findings of a soft-tissue mass in the neck, lungs, or abdomen, with or without a draining sinus or fistula, raise the possibility of actinomycosis in patients with clinical findings that suggest a subacute or chronic inflammatory process.

CT diagnosis of actinomycosis of the neck

Actinomycosis is an unusual bacterial infection that most often affects the head and neck region. Abscesses occasionally associated with a draining sinus may result secondary to extensive tissue destruction. We report the CT appearance in a case of actinomycosis of the neck. A thick walled enhancing mass with a low attenuation center was identified between the sternocleidomastoid muscle and the strap muscles of the neck. Enhancement of the adjacent muscles was present. Surgery confirmed an abscess with inflammation of the adjacent muscle. Histologic examination of the specimen showed the presence of multiple yellow (sulfur) granules containing Actinomyces. Computed tomography correctly determined the extent of the mass and lack of involvement of the deep structures of the neck.

Intraoral actinomycosis. Report of five cases

Five intraoral presentations of actinomycetes are recorded, in three of which the infection was almost certainly specifically due to the microorganisms. The importance of careful histopathologic examination is underlined, and the failure in some cases to investigate apparently simple infections bacteriologically is highlighted.

Periapical actinomycosis

Two cases of actinomycotic lesions of the periapical tissue in relation to the molars are described. The difficulty in obtaining a positive culture for actinomycetes in spite of definite histologic evidence of actinomycosis is highlighted. Besides antibiotics, the importance of planned treatment to deal with the underlying diseased periapical tissue and the tooth is emphasized.