Disseminated Actinomycosis: Multisystem Mimicry in Primary Care

Michael W. Felz, MD, Michael R. Smith, MD


South Med J. 2003;96(3) 

In This Article


Since the publication of Israel's initial treatise[18] 125 years ago, actinomycosis has remained an illness that has frequently eluded diagnosis because of prolonged, multisystem manifestations and clinical mimicry. Clinicians would be wise to consider a diagnosis of actinomycosis in patients with chronic draining abscesses of the jaw, neck, or skin, especially if these lesions have indurated or burrowing margins. Actinomycotic infection should also enter the differential diagnosis of destructive masses of bony structures or thoracic, abdominal, or pelvic organs if such processes display fistulization, sinus tracts, or extension across usual anatomic tissue planes. Surgical intervention for suspected carcinoma is often avoidable in hindsight, and a gratifying response can follow prolonged antibiotic therapy. Our patient's case illustrates many of the diagnostic pitfalls of this chronic disorder, and the impressive resolution of widely invasive infection with appropriate recognition and focused treatment. As Russo[2] aptly stated, "An awareness of the full spectrum of disease manifestations will expedite diagnosis and treatment and minimize the unnecessary surgical interventions and morbidity and mortality that all too often occur with actinomycosis." In our view, Perlow et al[9] best summarized this syndrome: "In the patient with actinomycosis, awareness of the problem by the physician is the initial key to a successful treatment plan."