Cervicofacial Actinomycosis Mimicking Osseous Neoplasm: A Rare Case

Abstract

A 13-year-old male child reported to the Department of Oral and Maxillofacial Pathology with the chief complaint of pain and difficulty in opening the mouth for last 6-7 months. Initially there was a small painful nodule over the right infra auricular region which gradually increased in size to attain the present dimensions. The patient did not give any history of trauma or tooth extraction. Many local physicians and dental surgeons were consulted and the patient received several courses of antibiotics and analgesics. However, he got no relief and concomitantly developed reduction in mouth opening. His past medical and family history were non contributory. He belonged to a poor socio-economic class.Extraoral examination revealed diffuse swelling involving right middle and lower third of face and a small, localized, painless, mobile mass measuring about 2.0 x 2.0 cm. just below and behind the right ear resulting in elevation of ipsilateral ear lobule, with normal overlying skin [Table/ Fig-1,2]. Nothing significant was noted on intraoral examination except for poor periodontal status and reduced mouth opening, Bleeding on probing was noted from the gingival margin of right maxillary lateral incisor and 1 st premolar [Table/ Fig-3]. Deviation of mandible towards left side was noted on opening the mouth.

Massive paediatric cervicofacial actinomycoses masquerading as an ulcerative malignancy

“…The word Actinomycosis comes from the Greeks where “aktino” refers to the radiating appearance of sulphur granules and “mykos” refers to mycelia relating to a fungal disease. It is a rare infectious disease in humans but much more common in animals such as cattle, horses, pigs, and dogs [ 11 ]. In 1845, Von Langenbeck reported the first case in humans and attributed it to a fungus.…”

“…In 1845, Von Langenbeck reported the first case in humans and attributed it to a fungus. In 1891, Israel and Wolff first isolated the microorganism from humans and Waksman showed that Actinomyces is a gram-positive bacterium; not a fungus in the 1960s [ 11 , 12 ]. Over 30 species have been identified, of which the most common microorganism causing infections in humans is A. israelii , and to a lesser extent A. naeslundii , A. meyeri , A. odontolyticus , A. viscosus , A. propionica , and A. gerencseriae [ 2 , 9 , 11 , 13 ].…”

“…These micro-organisms are filamentous, branched, gram-positive, anaerobic-to-microaerophilic, non-acid fast bacteria which are part of the resident microbiota of the oral cavity, gastrointestinal tract, and urogenital tract [ 2 , 9 , 11 ]. They are usually of low pathogenicity and in most cases, will cause disease only in the setting of poor oral hygiene, maxillofacial trauma, surgical procedures and dental manipulations leading to mucosal breakdown [ 12 , 13 ].…”

“…However, majority of cases occur in immunocompetent individuals with no underlying disease. The occurrence of AM in a female paediatric age group as seen in our case is a rare entity as the disease generally has a peak incidence in the 4th to 6th decade of life with a slight male predominance and has no predilection for age, season, race, or occupation [ 9 , 11 , 17 ].…”

“…In 1938, Cope clinically classified AM infection into three distinct groups based on the affected site: cervicofacial, pulmonothoracic and abdominopelvic occurring in 50 %, 30 % and 20 % of cases respectively [ 11 – 13 , 16 ]. The perimandibular region is the most common area to be affected in cervicofacial AM.…”