2011, Number 1
Cervicofacial actinomycosis
Rodríguez VM, Bravo EGA, Prado CH, Vick FR, Arroyo ES
Full text
Language: Spanish
References: 10
Page: 43-46
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ABSTRACT
The masses in the neck are a diagnostic challenge and chronic infections are rare, but should always be considered. Actinomycosis is caused by the bacterium A. israelii, and the most common manifestation is the cervicofacial. We report the case of a 43 year-old female patient with cervical mass of three months of evolution and with a history of dental infection. In the physical examination she presented a midline neck mass of 3 x 4 cm, indurated, fixed to the deep, with not defined borders and without nodes. The CT showed anterior to the cartilage and the thyroid gland, a heterogeneous density mass with mild peripheral enhancement. Fine needle aspiration biopsy was not specific. Three weeks later patient showed evidence of infection with fistulas in the skin. Drained material reported Ziehl Neelsen negative stain, positive Gram stain and positive culture for actinomycosis. Patient was treated with penicillin and clindamycin and showed satisfactory resolution. In the literature there are reported cases of actinomycosis with cervicofacial, thoracic, abdominal and pelvic clinical presentation, the cervicofacial one represents 40 to 55% of cases. It is characterized by a variable morphology and negative Gram and Ziehl Neelsen stains. In the oral cavity there are commensal microorganisms. Risk factors are poor oral hygiene, caries, diabetes mellitus, immunosuppression and malnutrition. The classic manifestation of cervicofacial actinomycosis is a chronic indurated mass, painless, with slow growing; it may progress to multiple abscesses, fistulae and sinusoid tracts, sulfur granules can drain. The treatment of choice is penicillin and surgery is recommended in extensive abscess drainage tracts and persistence of sinusoids.REFERENCES