Abstract
Periapical actinomycosis is a relatively rare form of cervicofacial actinomycosis, which typically involves the periapical region with subsequent potential spread to the jaw bones. We hereby present two cases of periapical actinomycosis. Both patients presented with jaw pain and “holes” in their gum and lacked the characteristic clinical features commonly seen in cervicofacial actinomycosis such as jaw mass, draining ulcers, sinuses and fistulae. The first patient was an immunocompetent host with chronic stable medical conditions but with a rather bad dentition requiring multiple recent teeth extractions. The second patient was edentulous, had refractory multiple myeloma, was on low-dose chronic steroids and pomalidomide therapy and therefore relatively immunocompromised. Both cases of actinomycosis were diagnosed by jaw bone histopathology, which showed characteristic sulfur granules and embedded Actinomyces-like organisms. The two patients had excellent clinical response to six months of penicillin therapy without any need for surgical intervention. The cases remind clinicians of including actinomycosis in the differential diagnosis of periapical lesions and illustrates the possibility of achieving cure with non-surgical treatment.
Highlights
Actinomycosis is often known as the great imitator, due to its mimicry of several clinical conditions.These conditions range from bacterial, fungal, mycobacterial and parasitic infections as well as benign and malignant neoplasms [1]
Periapical actinomycosis is a distinct form of cervicofacial actinomycosis which may or may not be associated with the classic discharging ulcer/sinus at the angle of the jaw [2,6]
Our first patient could be considered immunocompetent while the second patient was clearly immunocompromised, given her history of refractory multiple myeloma and chronic steroid and pomalidomide use
Summary
Actinomycosis is often known as the great imitator, due to its mimicry of several clinical conditions These conditions range from bacterial, fungal, mycobacterial and parasitic infections as well as benign and malignant neoplasms [1]. The finding of “holes” or large defects of exposed jaw bone inside the mouth cavity is a relatively uncommon presentation of cervicofacial actinomycosis. The first case is an immunocompetent host while the second is an immunocompromised host Both patients presented with “holes” in their gum and lacked the characteristic clinical features commonly seen in actinomycosis. Both cases were diagnosed by histopathology and had an excellent clinical response to six months of penicillin therapy
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