Actinomycosis of the posterior triangle: a case report and review of the literature

Abstract

Actinomycosis presents acutely as an abscess, or as a chronic lesion mimicking malignancy, tuberculosis, or aspergillosis. Most disease involves the mouth and its immediate site of lymphatic drainage, the anterior triangle of the neck. We present a case of actinomycosis at th e apex of th e posterior triangle, suspected of being a malignancy, and discuss the importance of being aware of this as a cause of neck lumps. The diagnosis is usually made late because of the difficulties in culturing the organism, or in identifying characteristic ‘sulphur granules’ in pus or biopsy specimens. For these reasons, the disease is underdiagnosed. When acute or chronic neck lesions prove difficult to diagnose, microscopy and prolonged anaerobi c culture of pus and biopsy specimens should be performed in addition to Ziehl-Neelsen staining, tuberculosis and fungal cultures. The tests should be repeated if negative. Specific treatment requires prolonged courses of antibiotics, despite adequate surgical excision, to prevent relapse.

Actinomycosis-Induced Lung Abscess and Empyema After the Treatment of Idiopathic Focal Segmental Glomerulosclerosis

“…9 While fever, weakness, fatigue and painful cellulitis are seen in the acute phase of the disease, lymphadenopathy occurs in the late period of the disease. 10 Fiberoptic bronchoscopy is not usually diagnostic for pulmonary actinomycosis unless there is a marked endobronchial lesion. For the diagnosis of pulmonary actinomycosis, lung biopsy is necessary to obtain histologically and microbiologically appropriate uncontaminated samples.…”

Carotid artery rupture and cervicofacial actinomycosis

“…Regional lymphadenopathy is typically absent until later stages [18]. Cervicofacial actinomycosis often involves the mouth and its immediate lymphatic drainage areas, with submandibular and submental lesions or lower in the anterior triangle [19,20]. Clinical presentations are usually abscessed or indurated masses, though ulcerous lesions of the oral mucosa have also been reported [14].…”

Nasopharyngeal Actinomycosis

“…The more common presentation is a chronic, slowly progressive, indolent infection that causes indurated infiltration and multiple abscesses and fistula [7]. In some patients, actinomycosis is an acute, rapidly progressive infection associated with pain, fever, soreness, and swelling.…”