[Cervical actinomycosis. A rare differential diagnosis of parotid tumor]

Actinomycosis is currently an uncommonly diagnosed human disease. However, it can still complicate trauma to the respiratory and digestive tracts, including operative procedures. A patient with cervicofacial actinomycosis commonly gives a history of recent dental manipulation which usually, involves extraction of a mandibular molar. The common initial symptoms of infection--such as, sudden onset of cervicofacial pain, swelling, erythema, edema and suppuration--can be absent. Infection due to actinomyces is a well-known mimic of malignancy is clinical, radiological and pathological findings. In the case described a 65-year-old man had a mass in his right parotid area. Because of its painless rapid growth with infiltration of the mandible as demonstrated by clinical findings and CT and MRI scans, we established an initial diagnosis of salivary gland malignancy. Salivary gland biopsy then revealed a histological picture of infection due to actinomyces. Therapy was initiated with intravenous amoxicillin and sulbactam. After 20 days of treatment diseased soft tissues and bone were resected. To prevent a relapse the patient received oral clindamycin for 6 weeks. After a followup of two years, the patient has remained free of disease.