Acute Primary Actinomycosis Involving the Hard Palate of a Diabetic Patient

Abstract

Actinomycosis is a relatively rare infection caused by saprophytic bacteria of the oral cavity and gastrointestinal tract that can become pathogenic. The chronic hyperglycemia of diabetes mellitus induces events that promote structural changes in various tissues and are associated with problems in wound healing. This infection remains largely unknown to most clinicians because of its different presentations, and palatal involvement is extremely rare. This report describes the case of a 46-year-old woman who was diagnosed with actinomycosis involving the hard palate. The main clinical, histopathologic, and therapeutic characteristics and differential diagnosis of actinomycosis are reviewed. To date, 3 cases of actinomycosis involving the hard palate have been reported.

Cervicofacial Actinomycosis of the Maxilla and HIV Infection: A Case Report.

“…The establishment of CA is associated with a series of situations that promote the penetration of a microorganism in the mucosa, such as a disease (caries, periodontal disease), or a surgical procedure (tooth extraction, orthognathic surgery) [4,9,11,12]. Periodontal disease and poor oral hygiene are considered important factors in the establishment and evolution of CA [1,6,7], which is compatible with the case described.…”

“…Actinomycosis is classified according to its anatomical position as cervicofacial, thoracic or abdominal, the first of which is the most common manifestation of the disease [3,9]. However, CA is an infrequent disease, which affects mainly young male subjects [4], as observed in this case report.…”

“…However, the disease is rare in the maxilla, with few cases reported in the literature [1][2][3][4]9,10].…”

“…Yet, some authors suggest that HIV patients are more susceptible to the disease [2,5]. Apart from this, diabetes [1,2,6,9], alcohol abuse [1,4] and use of immunosuppressant drugs have been implicated in CA in the oral cavity. In the present case, the patient had a CD4 count of 367 cells/μL, resembling a previous CA case report in a HIV patient found in the literature, who presented 480 cells/μL [5].…”

“…Commonly characterized by a hardened, slow-growing, painful mass, CA also produces abscesses, multiple fistulous pathways, and suppuration discharge containing typical 'sulfur granules' . In addition, the mandibular angle is the site most commonly affected by CA [3,6,9]. The factors associated with the host in the evolution of CA have not been clarified.…”