Fatally invasive actinomycosis masquerading as a tonsillar carcinoma

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Actinomyces is a bacterial rod found in the normal oral flora. It can gain entry to the submucosa via trivial wounds and ultimately lead to slow growing lesions which may mimic cancerous lesions. We present the case of an elderly, immunosuppressed woman who presented with a herald bleed from a tonsillar lesion. Despite initial operative arrest of the hemorrhage, she died of a carotid blowout. At autopsy, no sign of cancer was found, but rather an invasive actinomycosis. Although actinomycosis of the tonsil is well known and has even been described as mimicking tonsillar cancer, this is, to our knowledge, the first report of a carotid blowout secondary to actinomycosis.