A rare case of sinonasal actinomycosis – enigmatic presentation

Abstract

Actinomycosis is most commonly seen in cervico-facial, abdominal, genital and thoracic regions as discharging sinuses. Most common organism implicated is Actinomyces israelli, gram positive anaerobic commensal bacteria of aero-digestive tract. Actinomycosis of paranasal sinuses is an extremely rare entity with isolated case reports and small case series published in literature. Among all sinuses maxillary sinus is most commonly afflicted by this disease. Pathogenesis involves inoculation of the bacteria into the tissues through breach in mucosa by trauma or surgical procedure. It requires anaerobic environment to grow into soft tissues and invade bone. It warrants treatment in form of surgical debridement and long term antibiotic therapy. Here, we present one such rare case of sinonasal actinomycosis in a 60 year old diabetic male who earlier had been treated as a case of sinonasal mucormycosis about one year back. This case was managed successfully with debridement encompassing infrastructure maxillectomy followed by a long course of Penicillin group of antibiotic. Preoperatively there was a diagnostic dilemma whether we were dealing with chronic invasive fungal sinusitis or actinomycosis. Actinomycosis was confirmed postoperatively on histopathology and microbiology.