Invasive sinonasal actinomycosis

Abstract

Actinomycosis is a rare anaerobic bacterial infection typically caused by Actinomyces israelii. Although part of normal flora in the oral cavity, and respiratory and digestive tracts, A israelii can give rise to pathologic infections most commonly reported in the oral cavity from odontogenic causes. We present a rare case of invasive actinomycosis presenting with extensive midface destruction involving the maxilla and paranasal sinuses, with mucosal necrosis mimicking an aggressive neoplasm. The diagnosis is usually reached only after histopathologic analysis showing characteristic sulfur granules with filamentous gram-positive, non-acid-fast bacteria. We review the literature on its epidemiology, clinical presentation, diagnosis, treatment, and prognosis.

Intracranial Complication of Rhinosinusitis from Actinomycosis of the Paranasal Sinuses: A Rare Case of Abducens Nerve Palsy

“…It is a rare disease, which may explain why there is often little clinical suspicion leading to frequent delays in diagnosis and appropriate treatment [6]. There is a male predominance (1.5–3 : 1) and it generally affects patients from 40–70 years, without racial predilection [7, 8]. …”

“…Few cases of paranasal sinus actinomycosis have been reported [1, 5–8]. It should, however, be suspected when a patient with chronic sinusitis does not respond to medical therapy or has a history of facial trauma, dental disease, or dental treatment [1, 4].…”

“…Actinomycosis of the paranasal sinuses (PNS) is very uncommon and has been documented in only a few case reports [1, 5–8]. The most affected region is the maxillary sinus but can involve the ethmoid or sphenoid sinuses [1].…”

Actinomyces and Related Organisms in Human Infections

“…Another report described an ulcer-type actinomycotic lesion with A. odontolyticus on the oral mucosa of a patient with diabetes (69). Other locations for actinomycotic lesions categorized as cervicofacial actinomycosis include, for instance, the nasal and sinus region (70)(71)(72); pharynx (73,74); larynx/tonsillae (75-78); middle ear, mastoid, and/or temporal bone (79)(80)(81); and skull base with the craniovertebral junction (82). A somewhat more distant location is the esophagus, from where actinomycotic lesions have also been recovered in both immunocompetent and immunocompromised individuals (83,84).…”

A rare case of sinonasal actinomycosis – enigmatic presentation

“…Actinomycosis most commonly occurs in the cervico-facial region followed by abdominal, genital and thoracic regions as discharging sinuses. 3,6 Actinomycosis of paranasal sinuses is an extremely rare entity with isolated case reports and small case series published in literature. Among all sinuses, maxillary sinus is the most commonly afflicted sinus (>50%), by this disease.…”