Tonsillar Actinomycosis Associated With Cervical Lymphadenopathy: A Rare Benign Condition Mimicking Malignancy

Tonsillar actinomycosis is an uncommon chronic infection that can clinically and radiologically mimic malignancy. Because of its nonspecific presentation and tumor-like appearance, particularly when associated with cervical lymphadenopathy, it often poses a diagnostic challenge. A 20-year-old patient presented with a four-month history of progressive left tonsillar hypertrophy. Nasofibroscopy showed an irregular tonsillar surface with nasopharyngeal bulging, raising suspicion of a neoplastic lesion. Contrast-enhanced CT revealed asymmetric left tonsillar enlargement with homogeneous thickening of the nasopharyngeal wall and suspicious contralateral lymph nodes. Laboratory findings were within normal limits. The patient underwent left tonsillectomy with adenoidectomy. Histopathological examination demonstrated tonsillar hyperplasia containing Actinomyces colonies and adenoidal lymphoid hyperplasia, without evidence of malignancy. The patient received a six-week course of oral amoxicillin, resulting in complete regression of the cervical lymphadenopathy and no recurrence during follow-up.This case underlines the importance of considering tonsillar actinomycosis in the differential diagnosis of unilateral tonsillar hypertrophy mimicking malignancy, especially when accompanied by cervical lymphadenopathy. Early histopathological diagnosis and combined surgical and antibiotic therapy ensure optimal outcomes while avoiding unnecessary radical procedures.