Actinomycosis of the Nasal Septum: A Rare Entity

Abstract

Actinomycosis is a rare bacterial infection that can affect almost any site in the body. Its occurrence at the nasal septum is extremely rare. We present the case of an 84-year-old diabetic woman, with a past medical history of breast cancer that came to medical attention because of progressive nasal obstruction and severe sleep apnea. Nasal endoscopy revealed a submucosal mass at the anterior nasal septum obstructing both nasal cavities and extending to the anterior hard palate. With a cancer metastasis in mind, she was submitted to surgical resection of the lesion through a Rouge-Denker approach, with the final histologic diagnosis of actinomycosis. She was then treated with a three-month cycle of amoxicillin and remains without recurrence. This case describes a rare disease that should be considered in the differential diagnosis of sinonasal lesions, especially in diabetic patients and after dental procedures.

Short-Term Topical Antibiotic Treatment in Nasal Cavity Actinomycosis: Case Report and Literature Review

“…In addition, systemic diseases, such as diabetes and immunosuppression, are known risk factors for actinomycosis. [1][2][3][4][5] However, in our case, the patient had no risk factors other than severe vomiting prior to the diagnosis. Therefore, in this case, it seems that Actinomyces, which exists as a normal strain in the gastrointestinal tract, moved into the nasal cavity due to nasal reflux of gastric contents through vomiting and formed a lesion.…”

“…Actinomyces are normal flora in human mucosal tissue, such as the oral cavity and gastrointestinal and genital organs. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] However, sometimes it can become pathogenic. This is called actinomycosis and usually occurs following the destruction of normal mucosal tissue in the presence of other bacteria, especially in anaerobic environments, which enables the growth of these colonies.…”

“…According to our literature review, besides our case, there have only been 12 cases reported of actinomycosis occurring in the nasal cavity, such as the nasal septum, nasal floor, or the turbinates (Table 1). [1][2][3][4][5][6][8][9][10][11][12][13] Actinomyces is an anaerobic bacterium. Therefore, for this organism to act as a pathogen in the human body, it is necessary that the surrounding environment be anaerobic.…”

“…In general, due to its weak infectivity in the human body, it usually causes infection through damaged mucosa in patients undergoing longterm steroid treatment, or patients with diabetes or an immunodeficiency disease. [1][2][3][4][5] Although the most common clinical form of actinomycosis is cervicofacial, involvement of the nose, such as the nasal cavity, is extremely rare. [1][2][3][4][5][6][7][8][9][10][11][12][13] We report a rare case of nasal actinomycosis caused by re-sidual vomiting in the nasal cavity in of a healthy child with no special medical history.…”

“…[1][2][3][4][5] Although the most common clinical form of actinomycosis is cervicofacial, involvement of the nose, such as the nasal cavity, is extremely rare. [1][2][3][4][5][6][7][8][9][10][11][12][13] We report a rare case of nasal actinomycosis caused by re-sidual vomiting in the nasal cavity in of a healthy child with no special medical history. The purpose of the study was explained to patient and her guardians, with all providing written informed consent for use of patient's medical informations.…”