Nasopharyngeal Actinomycosis: A Rare Cause of Nasal Airway Obstruction

Abstract

Nasopharyngeal actinomycosis is a rare clinical disease. It can occur after nasal trauma or surgical manipulation. It is also reported to occur without prior trauma, making diagnosis difficult. We report a case of nasopharyngeal actinomycosis that presented as nasal airway obstruction causing snoring and mimicking nasopharyngeal carcinoma. To our knowledge, only a few other cases of nasopharyngeal actinomycosis have previously been published, most coming after mucosal trauma. Diagnosis is made by observing the bacteria or its associated sulfur granules in the biopsy specimen. This anaerobic organism is difficult to culture. Treatment consists of wide debridement and prolonged antibiotic therapy, with good prognosis.

Actinomyces and Related Organisms in Human Infections

“…Another report described an ulcer-type actinomycotic lesion with A. odontolyticus on the oral mucosa of a patient with diabetes (69). Other locations for actinomycotic lesions categorized as cervicofacial actinomycosis include, for instance, the nasal and sinus region (70)(71)(72); pharynx (73,74); larynx/tonsillae (75-78); middle ear, mastoid, and/or temporal bone (79)(80)(81); and skull base with the craniovertebral junction (82). A somewhat more distant location is the esophagus, from where actinomycotic lesions have also been recovered in both immunocompetent and immunocompromised individuals (83,84).…”

Nasopharyngeal Actinomycosis

“…High-dose penicillin is the antibiotic of choice [9]. The duration of treatment may be variable among different centres but a treatment of one to three months is recommended.…”

Actinomycosis of the Nasal Cavity: Case Report and Literature Review

“…The presence of other surrounding commensal flora provides a functional anaerobic environment allowing the Actinomyces to flourish. 3 Actinomycosis is slow-growing and spreads directly through tissue without regard to fascial planes or anatomic barriers. Hematogenous and lymphatic spread does not usually occur.…”

“…In some forms of actinomycosis, such as nasopharyngeal actinomycosis, these tracts have never been reported. 3 A less common manifestation of actinomycosis is an acute, tender, fluctuant mass that progresses rapidly. In this form, constitutional symptoms such as fever, fatigue and pain are noticeable.…”

“…These include the tongue, palate, paranasal sinuses, posterior triangle of the neck, and nasopharynx. 2,3,4 The genus Actinomyces is composed of a unique group of anaerobic, Gram-positive rods which include 28 different species. 1 These bacteria whose name literally translates in Greek to "ray fungus" resemble fungal hyphae by forming branching filaments.…”