Tonsillar actinomycosis presenting as expectorated debris

Actinomycosis and tonsillar disease

A 10-year-old female presented with complaints of submandibular swelling, sore throat, painful deglutition, difficulty in speech and fever. The patient gave history of recurrent tonsillitis associated with snoring and breathing difficulty during sleep. Oral examination revealed inflamed, hypertrophied tonsils and dental caries. Throat swab culture was positive for β-haemolytic streptococci. The patient underwent elective tonsillectomy and histopathological examination revealed characteristic colonies of actinomycetes. The patient was put on intravenous penicillin and after 6 months of follow-up is disease free. The report recommends that histopathological examination must be performed in cases of recurrent tonsillitis with tonsillar hypertrophy. Microscopic examination may reveal actinomycetes which may not be evident on culture; treatment requires a longer course of high-dose penicillins. This further supports the view that actinomycetes have a causal association with recurrent tonsillitis and tonsillar hypertrophy.

[Tonsillar actinomycosis manifested as expectorated debris]

Actinomycosis is a festering bacterial infection frequently affecting the cervicofacial area, for which the germs responsible are Gram-positive bacilli of Actinomyces sp. We present a case of atypical presentation of actinomycosis, in the shape of repetitive mass in the tonsillar fossa with complex therapeutic management.