A case of primary cutaneous actinomycosis

Primary actinomycosis of the big toe: a case report and literature review

Actinomyces are Gram-positive branching bacteria that are part of the human gastrointestinal microflora. These organisms can cause actinomycosis, which is a slowly progressive suppurative infection involving the cervicofacial region. Primary involvement of extremities is very rare. Here, we present primary actinomycosis of the lower extremity and a review of related literature. A 35-year-old female from Al-Kharj City (agricultural area) presented to our plastic surgery clinic with complaints of a large mass on the left big toe that caused embarrassment and difficulty in wearing footwear. The patient underwent wide local excision and coverage of the big toe defect with Kutler bilateral V-Y advancement flaps. A high index of suspicion is required to diagnose actinomycosis in subacute or chronic inflammatory soft tissue lesions. Proper surgical intervention and antimicrobial are essential to treat the disease. We conclude that a high index of suspicion is required to diagnose actinomycosis in subacute or chronic inflammatory soft tissue lesions.

Primary cutaneous actinomycosis:a case report

Actinomycosis is a subacute or chronic suppurative bacterial infection caused by filamentous gram positive, anaerobic to microaerophilic non acid fast bacilli primarily of the genus Actinomyces that normally colonize the mouth, colon and vagina. Primary cutaneous actinomycosis is a rare entity and is generally associated with trauma. We report a case of primary cutaneous actinomycosis of the back and left axilla in a 32-year-old female patient with no suggestive history of trauma.The diagnosis was suggested by the characteristic lesions with multiple discharging sinuses draining sero-sanguinous fluid scattered all over the lesions. Gram positive bacilli with plenty of pus cells were demonstrated in the direct examination of the discharging pus. Diagnosis was confirmed by isolation of the organisms by anaerobic culture giving typical molar tooth colonies. Final confirmation was done by histopathological examination.

Cervicofacial actinomycosis mimicking sebaceous cyst

Actinomycosis is a rare, torpid, suppurative and chronic granulomatous infection caused by a Gram-positive organism that was initially thought to be a fungus. These organisms normally live as commensals in the human oral cavity, respiratory and digestive tracts, but become invasive when they gain access to the subcutaneous tissue through a musosal lesion, the triggering events being dental caries, dental manipulation and maxillofacial trauma. It is often misdiagnosed as it can mimic numerous infectious and non-infectious diseases. We describe an interesting case of cervical actinomycosis that was misdiagnosed as sebaceous cyst and precisely identified after histopathological examination of the tissue.

Actinomyces meyeri cutaneous actinomycosis

Actinomyces meyeri cutaneous actinomycosis is a very rare disease. It often results from contiguous dissemination of an underlying focus. We report a case of pulmonary actinomicosis with secondary cutaneous involvement which led to the diagnosis. A 51-year-old man presented with an indurated, erythematous plaque on his right chest wall. He had been diagnosed with pneumoniae one month prior ago and received antibiotic treatment but symptoms persisted. Fibrobroncoscopy was normal and bronchoalveolar lavage samples were negative. The cutaneous plaque evolved with fistulization and drainage of serohematic material with white grains. Actinomyces meyeri was cultured from bacteriologic samples. Ceftriaxone and doxiciclin were administered for a total of 12 months with complete resolution of the clinical condition.

Extensive actinomycosis of the face requiring radical resection and facial nerve reconstruction

We present a case of extensive actinomycosis of the face, which appeared after dental surgery. Since antibiotic therapy was ineffective, the lesion was radically resected, and the skin, soft tissue and facial nerve were reconstructed using a free rectus abdominis musculocutaneous flap and simultaneously harvested intercostal nerves. Successful reanimation of the face was achieved 14 months postoperatively.

Primary cutaneous actinomycosis of the forehead

Actinomycosis is a granulomatous suppurative bacterial disease caused by anaerobic actinomyces, which presents primarily with the cervico-facial, thoracic, abdominal or pelvic form. Cutaneous involvement is well documented and it is usually secondary to local extension or exceptionally to ematogenous spreading from visceral sites. Primary cutaneous actinomycosis is very rare and usually associated with external trauma and/or local ischemia. We report on the case of a primary cutaneous actinomycosis of the forehead in a 59-year-old man with diabetes mellitus who had had a preceding cranial trauma and several cutaneous reconstructive surgical procedures. The patient was treated successfully with combined antibiotic therapy.

A suspected case of primary cutaneous actinomycosis on the buttock

Primary cutaneous actinomycosis is rare and can mimic mycetoma, tuberculosis and nocardiosis. The results of cultures (aerobic and anaerobic) are not always positive. A high degree of clinical suspicion should be entertained and a combination regimen of penicillins with sulphonamides should be used for treatment. We report a patient with primary cutaneous actinomycosis over the buttock, who was successfully treated with amoxicillin and sulphonamides.