Unilateral Maxillary Sinus Actinomycosis with a Closed Oroantral Fistula

Cohn, Jason E.; Lentner, Mark; Li, Hui

doi:10.1155/2017/7568390

Cited by 10 publications

(11 citation statements)

References 8 publications

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“…1 In the head and neck region, this may follow a dental procedure like dental extraction or implant. 3,4 Actinomycosis of PNS is very rare and most such reported cases involved maxillary sinus. Poor oral hygiene, dental procedures, dental disease especially oroantral fistula, puncture wounds, and compound fractures predispose to actinomycosis in the PNS.…”

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confidence: 99%

Actinomycosis: An Unusual Cause of Maxillary Sinusitis

2020

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A 58-year-old lady, a known diabetic, presented with fever, left facial pain, swelling, and redness of 3 days duration. She reported a similar episode 3 months ago, which subsided with medications. There were no other ENT complaints. There was a notable past history of multiple discharging sinuses over the abdominal wall and around right hip which took few months to heal, several years back. The patient also gave history of undergoing tooth extractions and dental implantation 2 years prior to the current symptoms. On examination, there was diffuse swelling with erythema and tenderness over the left cheek. Rest of the ENT examination was unremarkable except for discharge and debris in left middle meatus on diagnostic nasal endoscopy (DNE). A contrast-enhanced computed tomography of paranasal sinuses (PNS) showed heterogeneous soft tissue density filling left maxilla and ethmoids, with no clear bony erosions (Figure 1). Endoscopic sinus surgery revealed mucopurulent discharge, debris, and underlying unhealthy inflamed mucosa in the left maxillary sinus and ethmoids which were sampled. Histopathology showed nonspecific chronic inflammation and granules with gram-positive thin, branching filamentous organisms. Anaerobic bacterial culture grew Actinomyces spp. She was treated with Co Amoxiclav for 2 weeks but defaulted further treatment till her review 3 months later when a DNE showed granular mucosa with yellow spots in the postoperative cavity. Although she was asymptomatic and repeat debridement and cultures were sterile, she was treated with oral amoxicillin 500 mg 3 times a day for 3 months. On follow-up 9 months later, she was asymptomatic with no endoscopic evidence of recurrence. Actinomycosis is a slowly progressive infection with granulomatous and suppurative features commonly involving the cervicofacial, thoracic, abdominal, and genital areas. 1 Although almost 50% of actinomycosis involve head and neck region, the disease is relatively rare in nose and PNS. 2 Actinomycosis is caused by Actinomyces israelii, a grampositive, anaerobic, saprophytic, human commensal bacterium commonly found in the mouth and aerodigestive tract. The

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confidence: 99%

Actinomycosis: An Unusual Cause of Maxillary Sinusitis

2020

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“…Surgical removal of the involved tissues and the restoration of sinus ventilation are important factors for treating both of these diseases. In general, long-term antibiotics (e.g., penicillin) therapy following endoscopic sinus surgery is considered to be the gold standard for treatment of the actinomycotic sinusitis (1)(2)(3)(4)(5)(6)(7)(8)(9). In the present case, lesion area was limited within the sinus.…”

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confidence: 71%

Sinusitis of actinomycosis infection : a case report

Ohbuchi¹,

Shimajiri

Kawamura³

et al. 2021

J. Med. Invest.

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Actinomycosis is an infection caused by anaerobic bacteria, primarily from the genus Actinomyces, which normally colonize the several regions including the mouth. Disruption of mucosa may lead to infection of virtually any site, but reports of involvement of the sinuses are rare. We report a case of an actinomycosis infection in the unilateral maxillary sinus. A 47-year-old female visited our hospital with a complaint of mild pain of left buccal region. Computed tomography (CT) revealed that the left maxillary and anterior ethmoidal sinus cavities were opacified along with a calcified fragment located close to the natural ostium. Thus, we provisionally diagnosed as a fungal sinusitis. She underwent trans-nasal endoscopic sinus surgery. The sinuses were opened and the caseous material was removed. The histopathological examination suggested an actinomycosis, but not fungal, infection. The patient's postoperative course was uneventful. No evidence of recurrence has been seen over the 30 months of the postoperative follow-up period. In case of the aggressive actinomycotic sinusitis, extension into the adjacent organs could be occurred. We should be aware that sinusitis of actinomycosis infection could progress in patients with risk factors such as diabetes and immunodeficiency.

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“…Features such as responsiveness to antibiotics, presence of unique risk factors, and imaging findings can raise suspicion for an actinomycotic process, but a definitive diagnosis of actinomycosis requires confirmed presence of the pathogen on the histopathological exam and/or culture [ 8 ]. Prior studies indicate that risk factors for developing actinomycosis of the sinuses include prior dental procedures, oroantral defects, and immune deficiency [ 9 , 10 ]. Classic imaging findings of paranasal actinomycosis generally involve opacification of the maxillary sinus, either unilaterally or bilaterally.…”

Section: Discussionmentioning

confidence: 99%

Actinomyces Acute Rhinosinusitis Complicated by Subperiosteal Abscess in an Immunocompromised 12-Year-Old: Case Report and Literature Review

Nimmagadda

Man

Benoit

et al. 2022

Case Reports in Otolaryngology

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Objective. To describe a rare case of pediatric actinomycotic rhinosinusitis with orbital subperiosteal abscess and review the current literature to assess methods of diagnosis, treatment modalities, and outcomes with appropriate treatment. Methods. A case report and a review of the literature. Results. A 12-year-old patient with Crohn’s disease on infliximab presented with rhinosinusitis with orbital subperiosteal abscess formation. Endoscopic sinus surgery was performed and cultures grew actinomyces. A prolonged course of antibiotics was started, resulting in the complete resolution of the infection. In a literature review, all cases of uncomplicated and complicated actinomyces rhinosinusitis managed with appropriate surgery and prolonged antibiotics resulted in a cure. Our case is the first reported in a pediatric patient and the first taking immunosuppressive medication. Overall, only 3 cases of actinomyces rhinosinusitis in immunosuppressed individuals have been reported, each with uncontrolled diabetes and each also responded well to surgery and appropriate antibiotics. Conclusion. Actinomycosis of the paranasal sinuses poses a diagnostic challenge, with infections varying widely in presentation and extent of disease. A high index of suspicion, appropriate testing, and early aggressive treatment are critical in managing patients with this infection. Our case and prior published studies show that actinomyces rhinosinusitis can be successfully managed with endoscopic sinus surgery, abscess drainage as necessary, and a prolonged course of antibiotics, even in immunocompromised and pediatric populations.

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Unilateral Maxillary Sinus Actinomycosis with a Closed Oroantral Fistula

Cited by 10 publications

References 8 publications

Actinomycosis: An Unusual Cause of Maxillary Sinusitis

Actinomycosis: An Unusual Cause of Maxillary Sinusitis

Sinusitis of actinomycosis infection : a case report

Actinomyces Acute Rhinosinusitis Complicated by Subperiosteal Abscess in an Immunocompromised 12-Year-Old: Case Report and Literature Review

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