Massive paediatric cervicofacial actinomycoses masquerading as an ulcerative malignancy

Abstract

BackgroundPaediatric cervicofacial actinomycosis is a rare infectious disease caused by Actinomyces spp. and usually presents as a chronic, suppurative and granulomatous inflammation with a propensity to mimic malignant conditions.Case presentationWe discuss the case of an 11-year-old African female who presented with a chronic disfiguring cervical mass evolving over a 9 months period for which she had several unyielding consultations. Appropriate clinical and para-clinical evaluations were paramount to the diagnosis of an Actinomyces infection. We review the literature on its epidemiology, clinical presentation, diagnosis, treatment and prognosis.ConclusionActinomycosis still poses a diagnostic challenge. It is important for clinicians to consider the possibility of such rare infections in apparently malignant looking masses and also in lesions not responding to several antimicrobial treatments. The condition generally carries a good prognosis if recognised early and histopathological diagnosis is the gold standard.

A rare case of Actinomycosis of the pyriform sinus mimicking malignancy

“…The clinical presentation is varied and can mimic malignancy as in our case or even tuberculosis. ctinomycosis misinterpreted as malignancy are reported in the literature [5,[11][12][13]. The differential diagnosis of malignancy ranges from congenital cysts, inflammation, and infection to benign tumours.…”

Cervicofacial Actinomycosis in the Pediatric Population: Presentation and Management

“…5,7 Its tendency to persist, spread to adjacent tissue, and cause significant morbidity if not treated for extended periods with a penicillin-based therapy makes it important to confirm the diagnosis and initiate appropriate management. 8 Anerobic cultures are required for diagnosis and should be obtained in an atypical pediatric head or neck mass. 9 Appropriate treatment often includes both medical management with penicillin-based antibiotics to treat a potentially polymicrobial infection, and surgery for extensive or recurrent disease.…”

A Case of Lumpy Jaw Syndrome In A Teenage Girl

“…Predisposing conditions include poor oral hygiene and oral mucosa trauma. 1,2,3 Actinomyces infections pose a diagnostic challenge, especially because they must be distinguished from neoplastic etiologies and other infections. In most reported cases in the literature, actinomycosis is not suspected at the clinical onset of symptoms.…”

“…In most reported cases in the literature, actinomycosis is not suspected at the clinical onset of symptoms. 2,3 However, an early diagnosis is important, since it is a treatable condition and prompt diagnosis can avoid potentially unnecessary workup and intervention. 4 Also, Actinomyces' growth is very fastidious, and microbiological diagnosis often requires prolonged incubation times (up to 21 days).…”

“…4 Effective treatment of actinomycosis often requires both surgical management and prolonged antibiotic therapy. 1,2,3,4 Actinomyces species are universally susceptible to penicillin, amoxicillin and clindamycin, and a 4-6 weeks high-dose parenteral regimen is usually recommended followed by 2-12 months of oral penicillin4 or clindamycin.…”