Atypical presentations of actinomycosis

Background. Actinomycotic infections of the cervicofacial region are uncomm on. Most major medical centers report approximately one case per year. Pres enting clinical manifestations are confusing because they often mimic other disease processes. Diagnosis may be difficult due to a general lack of fam iliarity with the disease and the fastidious nature of the organism in cult ure. The cervicofacial manifestations of actinomycosis are varied, and a hi gh index of suspicion is required to make an accurate and timely diagnosis. Methods. Retrospective chart review with the presentation of four unusual c ases of actinomycosis were performed. Results. Two patients were initially seen with dysphagia from a tongue base mass. The third patient was initially seen with a 9-week history of worsen ing hoarseness and strider. Examination revealed an ulcerative lesion of th e left hemilarynx and pyriform sinus. All three patients were thought to ha ve a neoplastic process. Diagnosis was made on histologic examination of a tissue biopsy. The fourth patient was initially seen with a buccal space ma ss that was draining externally. Culture of the purulent drainage revealed Actinomyces. In all four cases, symptoms resolved after appropriate antimic robial therapy. Conclusions. Actinomycosis of the head and neck, although rare, is an impor tant entity to the otolaryngologist. A confusing clinical presentation comb ined with the fastidious nature of the organism make for a difficult diagno sis. A high index of suspicion is required to make an accurate diagnosis an d institute the appropriate antibiotic therapy. (C) 1999 John Wiley & Sons, Inc.