A Rare Localization of Actinomycosis Mimicking Ulcerative Malignancy

Actinomycosis is a chronic, suppurative, and granulomatous process caused by Actinomycetes, saprophytic bacteria normally residing in the oral cavity. It can involve any organ, but the cervicofacial disease is the most frequent. Pharyngolayngeal involvement is rare and usually occurs secondary to the oral or cervical disease. There are few cases of primary pharyngolaringeal actinomycosis described in the literature. A rare case of pharyngeal actinomycosis mimicking an ulcerative malignancy in a 63-year-old man is reported. The patient was treated successfully with long-term antibiotic therapy. The clinical and pathological features and the aspects of diagnosis and treatment of cervicofacial actinomycosis are discussed. 1. Introduction Actinomycosis is an uncommon bacterial infection characterized by a chronic, suppurative, and granulomatous process due to Actinomycetes. They are usually saprophytic bacteria of the oral cavity and the digest tract, but sometimes can lead to local and diffuse infections. The infection is caused by a mixture of microbes with a predominance of the Actinomyces israelii, a gram-positive anaerobic bacillus. Five species of Actinomycetes have been identified: israelii, bovis, naeslundii, viscous, and odontolyticus. All these species are normal flora of the oral cavity with exception of bovis [1]. In 1938 Cope first classified actinomycosis into 3 different forms: cervicofacial, pulmonothoracic, and abdominopelvic, respectively, 50%, 30%, and 20% of cases [2]. The predisposing factors are represented by debilitating conditions such as malignancy, diabetes, and immunosuppression [3]. Cervicofacial actinomycosis is also more frequent in people with poor oral hygiene and oral mucosal trauma. The fifth decade of life is the most affected, and there is a little male prevalence. Actinomycosis located at the cervicofacial district classically presents a slowly growing, firm, painless, and possibly suppurating submandibular mass, but it can also present a rapidly progressive, painful, and fluctuant infection anywhere in the neck or face associated with fever and leukocytosis. Racial predisposition or geographic factors are unknown. Actinomycosis is an insidious disease, and its propensity to mimic different pathologies, such as tuberculosis or carcinoma, is well known. CT and MR are aspecific for diagnosis, but they can help in defining the localization and the extension of the lesion [4]. The certain diagnosis is based on cytology (FNAC) and/or biopsy [5]. We report a rare case of pharyngeal actinomycosis mimicking an ulcerative