Brain abscess caused by chronic invasive actinomycosis in the nasopharynx

Abstract

Rationale:Actinomycosis is a rare anaerobic, gram-positive bacterial infection caused by Actinomyces, which is part of the normal flora in the oral cavity and respiratory and female genitourinary tracts. The cervicofacial area is the most common site of involvement, and involvement of the central nervous system is rare.Patient concerns:We report a case involving a 51-year-old woman who developed an actinomycotic brain abscess 15 months after the treatment of noninvasive nasopharyngeal actinomycosis, which recurred as an invasive form.Diagnoses:Histopathological examination of the surgical specimens revealed actinomycosis.Interventions:The patient was treated by surgical drainage of the brain abscess and long-term antibiotic treatment.Outcomes:Follow-up brain imaging performed 12 months after surgery showed complete resolution of the brain abscess, and there were no further signs or symptoms of infection.Lessons:Physicians should be aware of the typical clinical presentations of cervicofacial actinomycosis. Moreover, they should know that actinomycosis may mimic the process of malignancy at various anatomical locations.

A Case of Actinomycosis in the Rosenmüller’s Fossa

“…Actinomycosis in the nasopharynx shows symptoms similar to nasopharyngeal cancer, including nasal obstruction, otitis media with effusion, otorrhea, headache, and epistaxis. [5][6][7] Intracranial complications, such as brain abscess 2 and internal carotid artery obstruction, 4 can develop. The endoscopic findings also mimic those of nasopharyngeal cancer.…”

Actinomycosis of tongue: Rare presentation mimicking malignancy with literature review and imaging features

“…Our literature search did not reveal any case report describing local or distant recurrence of lingual actinomycosis after being treated successfully with antibiotics over a prolonged time. Huang et al (2018) reported actinomycotic brain abscess which developed 15 months after 6 weeks of successful treatment of nasopharyngeal actinomycosis [25] . Long-term surveillance, therefore, is still necessary for patients suffered with actinomycosis in any particular area in cervicofacial region.…”

Microbiological and Clinical Aspects of Cervicofacial Actinomyces Infections: An Overview

“…Initiation of therapy in cervicofacial infections is also important for the containment of the infection, as in untreated cases, the pathogens may disseminate to distant organs—such as the brain, lungs, and gastrointestinal tract—resulting in concomitant infection [19,21,22,23,24,25,26,27,28,29]. In fact, hematogenous spread of bacteria from cervicofacial infections are the second main causes of brain and lung actinomycoses [32,33,34,35,36]. Actinomyces species are frequently isolated from the bloodstream of patients, following dental extractions (transient bacteremia) or due to increased permeability of oral mucosa [37,38].…”