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Cervicofacial actinomycosis with paravertebral spread: a case report
J Abisheganaden1, K N Sin Fai Lam, L S Chew
1Department of Medicine, Alexandra Hospital, Singapore.
Singapore Medical Journal
|April 1, 1996
Summary
Cervicofacial actinomycosis, a rare infection, can extend to the paravertebral area. Prompt diagnosis and prolonged high-dose penicillin therapy are crucial for successful treatment of this challenging condition.
Area of Science:
- Infectious Diseases
- Microbiology
- Surgical Pathology
Background:
- Actinomycosis is a chronic bacterial infection caused by Gram-positive, filamentous bacteria of the genus Actinomyces.
- Cervicofacial actinomycosis is the most common form, but paravertebral extension is a rare presentation.
- Recurrent neck masses can indicate underlying infectious or neoplastic processes.
Observation:
- A 60-year-old male presented with recurrent neck masses, suggestive of cervicofacial actinomycosis with paravertebral extension.
- Diagnosis was confirmed through microbiological culture and histological examination of surgical drainage.
- The patient's condition required extensive in-hospital treatment.
Findings:
- High-dose intravenous penicillin therapy administered over an extended period led to significant clinical improvement.
- Surgical drainage provided diagnostic material and initial management of the abscess.
- Maintenance therapy with doxycycline was prescribed for six months post-initial treatment.
Implications:
- This case highlights the importance of considering actinomycosis in the differential diagnosis of complex neck masses.
- Aggressive and prolonged antibiotic treatment, particularly with penicillin, is essential for managing cervicofacial actinomycosis with paravertebral involvement.
- Early and accurate diagnosis through microbiological and histological analysis is critical for effective patient outcomes.