Facial Actinomycosis Mimicking a Cutaneous Tumor

Adem Özkan, MD; Adem Topkara, MD; Ramazan Hakan Özcan, MD

Disclosures

Wounds. 2017;29(1):10-13. 

In This Article

Abstract and Introduction

Abstract

Actinomycosis is a chronic granulomatous infection that commonly occurs in the cervicofacial region. Although Actinomcyes is an element of the normal oral flora, infections of the facial skin are very rare because of the entirely endogenous habitation of the organism. The authors report a case of facial actinomycosis, which mimicked a cutaneous tumor both clinically and surgically in a 44-year-old woman with chronic renal failure and Hepatitis C viral infection. The majority of cases can be treated with long-term antibiotics. However, a treatment-resistant abscess, a fistula, or postsurgical excision of the mass formation that are infected can be treated with antibiotics as soon as possible, and recurrence of infection is prevented. The treatment should consist of conservative surgery to obtain a firm histological diagnosis and to drain any collections.

Introduction

Actinomycosis is a chronic granulomatous infection that commonly occurs in the cervicofacial region.[1] It can also occur in abdominopelvic and pulmonothoracic sites and in the musculoskeletal and central nervous system. Any part of the cervicofacial site can be affected by actinomycosis infection. Although Actinomyces is an element of normal oral flora, infections of the facial skin are very rare because of the entirely endogenous habitation of the organism. However, in some cases actinomycosis can be locally destructive and progress to generalized infections, causing complications including abscess formation with risk of rupture, fistula formation, or spread to neighboring and distant organs.[2] The most frequently encountered species is Actinomyces israelii.[3,4]

The authors describe an unusual case of a 44-year-old woman with chronic renal failure and Hepatitis C viral (HCV) infection having primary cutaneous actinomycosis (PCA) of the left cheek. Infection probably occurred following direct inoculation of the bacteria after a previous surgery. The patient was diagnosed and successfully treated with surgical excision followed by antibiotic treatment.

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