Orofacial Actinomycosis Eroding Through Hard Palate: A Case Report.

Stephanie Liu, Charissa M Etrheim, Kevin M McDonald
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Abstract

Introduction: Actinomycosis is a rare, chronic, progressive bacterial infection caused by Actinomyces species with a reported incidence of 1 in 300 000. Actinomycosis has variable presentations and is commonly mistaken for malignancy and other infections, leading to delays in diagnosis and appropriate treatment. Actinomyces is a commensal bacteria found in the mouth, gut, and genitourinary tract. Actinomycosis tends to take advantage of anatomical defects for contiguous spread and can cause fistulas, sinus tracts, abscesses, and intrauterine device-associated infections.

Case presentation: A 78-year-old White male with known dental caries came to a primary care clinic 2 days after noticing a painless, nonbleeding mass eroding from his hard palate. After a tissue biopsy of the mass showed a diagnosis of actinomycosis and advanced imaging showed no intracranial involvement, he was treated with a 6-month course of antibiotics, including oral amoxicillin, oral amoxicillin-clavulanate, and intravenous ertapenem.

Discussion: There are several case reports of actinomycosis with variable presentations, such as cutaneous nodules and sinus tracts. These cases frequently are associated with dental infections and procedures, trauma, oral surgery, or prior head and neck radiation. The condition is often mistaken for other infections or malignancy, which can delay appropriate treatment and increase the risk of complications.

Conclusions: Actinomycosis is a rare bacterial infection with variable presentations occurring throughout the body. This patient responded well to a prolonged course of intravenous and oral antibiotics and had complete healing of his hard palate defect. Actinomycosis is frequently misdiagnosed, leading to delays in appropriate treatment.

口腔放线菌病侵蚀硬腭:病例报告
简介放线菌病是由放线菌引起的一种罕见、慢性、进行性细菌感染,据报道发病率为 30 万分之一。放线菌病的表现多种多样,通常被误认为是恶性肿瘤或其他感染,从而导致诊断和适当治疗的延误。放线菌是一种常见于口腔、肠道和泌尿生殖道的共生细菌。放线菌病往往利用解剖上的缺陷进行连续传播,可引起瘘管、窦道、脓肿和宫内装置相关感染:一名 78 岁的白人男性,已知患有龋齿,在发现硬腭上有一个无痛、不出血的肿块侵蚀两天后,来到一家初级保健诊所就诊。在对肿块进行组织活检确诊为放线菌病,且先进的影像学检查显示未累及颅内后,他接受了为期 6 个月的抗生素治疗,包括口服阿莫西林、口服阿莫西林-克拉维酸和静脉注射厄他培南:有多例放线菌病病例报告,其表现各不相同,如皮肤结节和窦道。这些病例通常与牙科感染和手术、外伤、口腔手术或头颈部放射治疗有关。这种病常被误诊为其他感染或恶性肿瘤,从而延误了适当的治疗,增加了并发症的风险:放线菌病是一种罕见的细菌感染,全身表现各异。该患者对长期静脉注射和口服抗生素疗程反应良好,硬腭缺损完全愈合。放线菌病经常被误诊,导致治疗延误。
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