An unusual case of intraoral actinomycosis: Case report and literature review

Abstract

Actinomycosis is an infrequent chronic suppurative granulomatous disease caused by commensal bacteria of Actinomyces species. It usually affects the orocervicofacial region and classically presents with chronic abscess or persistent discharging sinus tract formation along with “sulfur granules” and woody fibrosis. Bacteriological and histopathological examination confirming the presence of Actinomyces colonies is essential for diagnosis and treatment modalities to include long-term oral and intravenous antibiotics. We report a challenging case of a 38-year-old male who presented with pain, swelling, and numbness around the left upper jaw after undergoing dental extraction about 1 month back. No symptoms of discharging pus, sinus tract, or abscess formation or fibrosis were seen. Based on the clinical history and symptoms, a presumptive diagnosis of intraoral actinomycosis was made, but no organism could be cultured. Finally, surgical resection was done, and Actinomyces involving the first and second molar teeth of the upper left maxilla was confirmed on histopathology. Intraoral actinomycosis requires long-term antibiotic treatment, but in our patient, a newer treatment modality was attempted which yielded excellent results without any recurrence after 1 year.