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Abstract
Actinomyces is a relatively uncommon cause of infection of the head and neck. However, its presentation is usually atypical and can be difficult to recognize. In this case report, we present the diagnostic and therapeutic challenges that can arise from cervicofacial actinomycosis.
A 26-year-old woman from Northern Manitoba in her second trimester of pregnancy presented to the emergency department with a 2-month history of progressive pain and swelling of her right mandible. Imaging revealed lytic lesions involving the angle and ramus of the right mandible with possibility of osteosarcoma, and she was taken for hemimandibulectomy. Intraoperative specimens revealed Actinomyces odontolyticus. She was subsequently started on piperacillin–tazobactam that was later stepped down to amoxicillin–clavulanate with radiographic and clinical improvement of her osteomyelitis.
Cervicofacial actinomycosis may mimic several neoplastic, granulomatous and infectious conditions, and often require tissue culture for diagnosis. Therapy often necessitates a combination of surgical resection and prolonged medical therapy, which is tailored to the burden of disease in the individual patient.
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