S2513 Not All That Appears Like Oral Thrush Is Candidiasis: A Case of Oral Actinomycosis

Abstract

Introduction: Oral thrush is one of the most common infections that affect the oral cavity. The oral candidiasis lesions classically present as whitish confluent plaques on oral cavity examination of tongue, palate, and buccal mucosa. Oral thrush has long been associated with overgrowth of Candida albicans in the mouth in dialysis dependent patients, diabetics, immunocompromised, and who are on corticosteroid therapy. In this abstract we present a case of oral actinomycosis mimicking oral thrush upon presentation. Case Description/Methods: 51-year-old female a history of squamous cell esophageal cancer status post distal esophagectomy and gastric pull through operation 5 years ago. She with a presented with a chief complaint of odynophagia and recurrent episodes of dysphagia for solid foods that has been worsening since past few weeks. About 6 months ago the patient had an upper endoscopy, which was significant for acute gastritis and pyloric stenosis, which was dilated. No obvious thrush was identified during that visit. Patient was not on any immunosuppressive medication. A repeat upper endoscopy was performed at this visit which was revealing of thrush in the oropharyngeal area and chronic gastritis. Tongue brushings were obtained for cytopathological analysis, which were suggestive of actinomyces infection. The patient was started on amoxicillin therapy for 2 weeks, which resulted in resolution of thrush as well as her clinical symptoms. Other treatment alternatives for actinomycosis include doxycycline, clindamycin, ceftriaxone, and imipenem (Figure). Discussion: Actinomyces is a rare bacterium often found in the head and neck region. They are partially acid-fast, filamentous gram-positive microorganisms. They were originally classified with fungi organisms as they possess hyphae. Actinomyces is considered to cause chronic suppurative infection. However, actinomycosis infection of the tongue is rare, it usually presents as an abscess formation, draining sinus tracts, fistulae, and tissue fibrosis. The gold standard for the diagnosis of Actinomyces is histological examination. Identification of the underlying pathogen is crucial for management of these patients. Candida is treated with antifungals, however, for actinomyces the treatment is penicillin group of antibiotics. Therefore, it is important to have awareness for actinomyces in the setting of oral thrush for appropriate treatment.Figure 1.: Endoscopic Findings.