Actinomycosis of the Upper Lip

Abstract

Actinomycotic infections are known to have an association with difficulties in diagnosis and treatment. These infections usually involve the head, neck, thorax, and abdomen. Actinomycosis of the upper lip is a rare condition and an important one as well, because it can imitate other diseases. As the initial impression, it can easily be mistaken for a mucocele, venous lake, or benign neoplasm. An 82-year-old man presented with an asymptomatic normal skin colored nodule on the upper lip. Histopathologic findings showed an abscess and sulfur granules in the dermis. Gram staining results showed a mesh of branching rods. In this report, we present an unusual case of actinomycosis of the upper lip and discuss its characteristics and therapeutic modalities.

Unusual clinical presentation of actinomycosis mimicking mucocele

“…4 Involvement of oral mucosa is rare and there have been only five cases of actinomycosis of the lip reported in the English published work. 3 Mucocele, minor salivary gland tumor or infected cyst were initially diagnosed with inspection alone in the reported cases, as with our case. Histopathological findings of actinomycosis include central abscess containing multiple tangle of bacterial fragments, called sulfur granule, with peripheral eosinophilic terminal clubs.…”

“…2 With the presence of bacterial filament of less than 1 lm and negative acid-fast bacilli stain, nocardiosis, eumycetoma and botryomycosis can be differentiated. 3 In this case, a typical sulfur granule with Gram-positive filamentous bacteria of less than one 1 lm and absence of acid-fast bacilli established the diagnosis of actinomycosis. First-line therapy for actinomycosis is long-term use of penicillin-G or amoxicillin.…”

“…2 As it is a commensal organism found in the oral cavity, gastrointestinal tract and female genitalia, disruption of the mucosal barrier and change of resident microbial flora can induce the infection of the skin. 3 In this case, we consider that unconscious trauma on the lip could have triggered the development of the lesion. Cervicofacial actinomycosis is the most common type of actinomycosis that frequently presents as "lumpy jaw syndrome".…”

Surgical debridement as a treatment strategy for cervicofacial actinomycosis—Literature review and case report

“…In patients with deep infections, treatment for up to 12 months may be required if no surgical therapy is performed [ 3 ]. Table 1 summarizes cases presented in the literature [ [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] ].…”

Bacterial Diseases: Humans vs Microorganisms

“…Among oral mucosal membrane, actinomycosis usually involves the tongue and the oro-alveolar mucosa. [18] The developing granulomatous and suppurative lesions disrupts the mucosa and progresses into the deeper tissues producing a permanent discharge of purulent exudates. [17] A general characteristic of actinomycosis includes-chronic disease state, suppuration, formation of draining sinuses or fistulas as well as presence of -sulphur granules‖ in exudates.…”