Actinomycotic osteomyelitis of palate masquerading periapical pathology: A rare case report

Abstract

Osteomyelitis is an infection that is challenging to manage due to the poor vascularization of bone that favors the proliferation of microorganisms. We report a case of osteomyelitis occurring in endodontically treated teeth in the maxillary palatal region. Clinically and radiographically, it was initially diagnosed as osteomyelitis and was treated accordingly with antibiotics for 1 year with no reported healing. Later, biopsy was done and the findings were consistent with that of chronic osteomyelitis in association with infection by Actinomyces organisms. Thus, the case highlights the rare occurrence of actinomycotic osteomyelitis in maxilla and the importance of biopsy and histopathology which will help in correct diagnosis and rapid resolution through appropriate antibiotic therapy.

Actinomycosis in the maxilla of a young asymptomatic patient: unusual case report

“…Actinomycosis is a rare granulomatous suppurative disease caused by Actinomyces spp [3,4], originated from the Greek word "Aktino", which means radiant appearance of sulfur granules, and "Mykos", which labels the condition as mycotic disease [1,3]. However, actinomycetes are now grouped as bacteria, due to their composition in the cell wall, lack of nuclear membrane and lack of growth inhibition by antifungal agents [4].…”

“…This disease has, clinically, four types: thoracic, abdominopelvic, cerebral and cervicofacial [2]. The latter usually affects the body of the jaw, followed by the mental region and angle of the jaw, but rarely affects the maxilla or the temporomandibular joint [3].…”

“…The skin that covers the abscess is red to purplish and hardened on palpation [7]. The discovery of "holes" or large defects of the jaw bone within the oral cavity is a relatively unusual presentation of cervicofacial actinomycosis, when it results in osteomyelitis [3,4].…”

Actinomycotic Osteomyelitis of the Maxilla in a Patient on Phenytoin

“…Infectious maxillary sinusitis [ 14 ], an unhealed extraction socket, hyperglycemia [ 4 ], and immunosuppression caused by chemotherapy [ 16 ], can be predis-posing factors for maxillary osteomyelitis. Non-healing wounds after the long-term habitual use of chewing tobacco should be distinguished from actinomycotic osteo-myelitis [ 11 ]. Our patient had none of the above-mentioned symptoms or disorders.…”

“…After omitting repetitions, mandibular cases, and reports of osteomyelitis without actinomycosis, we found 11 articles that presented 13 cases ( Table 1 ) [ 3 , 6 , 7 , 9 - 16 ], of which, only 4 were men [ 6 , 9 , 11 , 12 ] and two were in the 5 th and 6 th decades of life [ 6 , 9 ]. To the best of our knowledge, this is the first time that phenytoin has been proposed as a risk factor for this condition.…”