Diagnosis: Cervicofacial actinomycosis
Direct Gram stain showed gram-positive cocci, so the patient was started on a 7-day course of cephalexin 500 mg tid. Five days later, the anaerobic culture grew Actinomyces neuii, revealing the diagnosis as cervicofacial actinomycosis; the patient stopped taking cephalexin. The patient was then switched to a 3-month course of amoxicillin 875 mg bid.
Actinomyces are natural inhabitants of the human oropharynx and gastrointestinal and genitourinary tracts.1-4 They are filamentous, gram-positive rods with characteristic sulfur granules (although these are not always present).1-4 It is believed that actinomycosis is endogenously acquired from deep tissue either through dental trauma, penetrating wounds, or compound fractures.2,4
The most common presentations of actinomycosis include cervicofacial (sometimes referred to as “lumpy jaw syndrome”), followed by abdominopelvic and thoracic/pulmonary, manifestations.2-4 Primary cutaneous actinomycosis is rare.5-9 Actinomycosis infection often manifests with indolent constitutional symptoms such as fatigue and anorexia.1 Most cases occur in men ages 20 to 60 years, although cases in women are increasingly being reported.2-4
Risk factors include poor dental hygiene or dental procedures, alcoholism, intrauterine device use, immunosuppression, appendicitis, and diverticulitis.2-4 The exact cause of this patient’s actinomycosis was unknown, as she did not have any known risk factors.
Furunculosis and sporotrichosis are part of the differential
Actinomycosis is often called a “great mimicker” due to its ability to masquerade as infection, malignancy, or fungus.1 The differential diagnosis for this patient’s presentation included bacterial soft-tissue infection (eg, furunculosis), infected epidermoid cyst, cutaneous tuberculosis, sporotrichosis, deep fungal infection, and nocardiosis.
Continue to: Furunculosis was initially suspected