Craniofacial Actinomyces osteomyelitis evolving from sinusitis

Abstract

Craniofacial Actinomyces osteomyelitis progression is rare, as patients are soon treated. A 56-year-old male smoker presented with sinusitis and was managed medically. This patient failed to follow up and presented 1 year later with erosive bony disease. He was managed medically and surgically; however, his disease evolved to include his midface, skull base, and cranium. He underwent staged debridement and free tissue reconstruction. His disease is controlled but not cured. The literature includes case reports and small series describing limited disease treated successfully with surgical and medical management. Although craniofacial Actinomyces osteomyelitis is uncommon, it can become debilitating. This case demonstrates how craniofacial Actinomyces osteomyelitis can progress and highlights the benefit of a multidisciplinary approach.

Actinomicosis en el hueso temporal. Reporte de un caso pediátrico

“…El curso de tratamiento tradicional es de 6-12 meses. [12][13][14][15] Puede acortarse si se realiza la resección quirúrgica de los tejidos infectados. Presenta favorable respuesta al tratamiento antibiótico instaurado y ausencia de afectación ósea.…”

Bony cystic lesion with associated submandibular lymphadenopathy on a background of breast carcinoma: an unexpected case of cervicofacial actinomycosis

“…8 9 This reinforces the importance of establishing the correct diagnosis promptly, so that the correct antibiotic regime can be commenced early to avoid further complications of inadequately treated actinomycosis, including bony destruction, abscesses, multiple draining fistulas and the need for aggressive debridement, potentially requiring free flap reconstruction. 3 Historically, actinomycosis was treated with long-term courses (usually 4-6 weeks) of intravenous antibiotics followed by oral doses. However, short course regimens have been proved to be successful.…”

Microbiological and Clinical Aspects of Cervicofacial Actinomyces Infections: An Overview

“…In the presence of fermentable carbohydrates, Actinomyces species also produce acid, leading to dental caries and tooth decay. The significance of these fimbriae is also pronounced in osteomyelitis, where they bind collagen and contribute to the pathogenesis of bone necrosis [63,64,65,66]. It has been described that A. meyeri has a great propensity for hematogenous dissemination; however, no differentiating virulence factor has been identified [22,35].…”