The Hidden Threat: Maxillary Hardware-Associated Actinomycosis in Diabetes

Actinomycosis is a chronic granulomatous infection caused by anaerobic Gram-positive Actinomyces species. While cervicofacial actinomycosis is the most common form, involvement of the maxilla is rare due to its rich vascular supply. Osteomyelitis of the maxilla, caused by actinomycosis, is an uncommon but serious condition that can lead to extensive local destruction and soft tissue involvement in patients with implanted hardware and underlying immunocompromised state. We present the case of a 46-year-old male with poorly controlled type 2 diabetes mellitus and a history of right maxillary hardware placement following a zygomatic arch fracture. He presented with acute right facial swelling, pain, and trismus. Imaging revealed signs of maxillary osteomyelitis and facial cellulitis. Cultures from the surgical debridement grew Actinomyces odontolyticus, Streptococcus epidermidis, Abiotrophia defectiva, and Veillonella parvula. The patient was treated with surgical removal of the infected hardware and a prolonged course of intravenous and oral antibiotics, resulting in full clinical recovery. This case highlights the importance of early recognition and aggressive management of actinomycosis-related osteomyelitis in high-risk patients. Poor dental hygiene, implanted hardware, and systemic immunocompromising conditions such as diabetes mellitus serve as key predisposing factors. Multidisciplinary management and long-term antimicrobial therapy are essential to successful outcomes.