A Case of Actinomycosis of the Maxillofacial Region

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  • 顎顔面放線菌症例
  • 臨床 顎顔面放線菌症例
  • リンショウ ガク ガンメン ホウセンキン ショウレイ

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Actinomycosis is an unusual inflammatory disease caused primarily by Actinomyces israelii, a Gram-positive anaerobic bacterium. The disease is characterized by board-like swelling with unclear borders, and multiple abscesses; since the swelling can have similar characteristics to those of malignant tumors, the diagnosis can be difficult.<br/>We report one case of actinomycosis of the maxillofacial region associated with carious teeth and chronic osteomyelitis of the mandible.<br/>The patient, an 88-year-old woman, complained of a swelling in the right maxillofacial region with pain and trismus. Purulent parotitis was suspected and treatment was started with a cephem antibiotic. However, the refractory parotitis became worse, with the formation of multiple abscesses in the parotid gland and destruction of the cheek skin. While histopathological examination revealed no evidence of malignancy and pus culture from the cheek abscess showed no significant bacterial growth, Actinomyces was detected on gram’s staining of the pus smear, and the two carious teeth, which were associated with chronic osteomyelitis and destruction of mandible in on the right side, were considered as the source of the infection. The carious teeth were extracted.<br/>The patient was treated with oral AMPC for 4 months, and has since shown no evidence of recurrence of the infection.<br/>Since the characteristics of the lesions in actinomycosis can be similar to those of malignant tumors and the condition is refractory to general treatments given for bacterial infections, it is important for clinicians to make a precise diagnosis of actinomycosis and provide prompt and appropriate treatment.

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