The Great Imitator: Cervicofacial Actinomycosis Masquerading as Cancer Recurrence

Area of Science:

• Head and Neck Surgery
• Infectious Diseases
• Oncology

Background:

• Cervicofacial actinomycosis is an unusual infection relevant to head and neck surgeons.
• Its presentation can mimic malignancy, complicating diagnosis, especially after irradiation.
• Low culture sensitivity further challenges identification.

Purpose of the Study:

• To report two cases of cervicofacial actinomycosis misdiagnosed as osteoradionecrosis.
• To highlight the importance of considering actinomycosis in the differential diagnosis of post-irradiation head and neck lesions.
• To emphasize the successful management of this condition with long-term antibiotics.

Main Methods:

• Clinical and radiological diagnosis of osteoradionecrosis.
• Histopathological analysis to rule out cancer recurrence.
• Subsequent diagnosis and treatment of cervicofacial actinomycosis.

Main Results:

• Two patients presented with lesions initially suspected to be osteoradionecrosis or malignancy.
• Histopathology revealed cervicofacial actinomycosis, not cancer recurrence or osteoradionecrosis.
• Both patients responded well to a prolonged course of antibiotics.

Conclusions:

• Cervicofacial actinomycosis should be considered in the differential diagnosis of head and neck lesions, particularly those mimicking malignancy post-irradiation.
• Histopathology is crucial for accurate diagnosis when initial assessments are inconclusive.
• Long-term antibiotic therapy is an effective treatment for cervicofacial actinomycosis.