J Rhinol.  2020 May;27(1):58-62. 10.18787/jr.2020.00308.

A Case of Chronic Invasive Actinomycosis in the Nasal Cavity

Affiliations
  • 1Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Gachon University, Gil Medical Center, Incheon, Korea

Abstract

A 57-year-old male patient with nasal congestion and nasal congestion, which occurred 1 month prior to the hospital visited. PNS CT and MRI was performed and revealed right orbital cellulitis, sinusitis and brain abcess. Surgical drainage was determined by rhinology, ophthalmology and neurosurgery. The right sphenoid sinus was identified as an open mucosal mucosa, and blackish mucosa was found on the right sphenoid sinus. Eucleation was performed. Infected orbital tissue removal and orbital abscess drainage were performed. Neurosurgery performed dura incision, drainage and removal of a large amount of abscess pattern, and duroplasty with artificial dura. Actinomyces odontolyti was identified by pus culture, and postoperative antibiotic treatment and dressing were performed, but infection aggravation persisted, resulting in deterioration of general condition, multiple organ damage, and cerebral infarction.

Keyword

Actinomycosis; Invasive actinomycosis; Sinusitis; Transnasal endoscopic surgery; 방선균증; 침습성방선균증; 부비동염; 내시경하 부비동수술

Figure

  • Fig. 1. Picture of patients face when visit hospital. Redness around the left entire eyelid, accompanied with swelling. Also, yellowish discharge was drainage from upper eyelid (A). Endoscopic images show a whitish discharge in the right nasal cavity (B).

  • Fig. 2. Computed tomography scans. Soft tissue density and neighboring bone destruction are seen at the Rt.temporal area, periorbital area and superior orbital area in the coronal view (A) and axial view (B).

  • Fig. 3. Preoperative MRI. Axial T1-weighted image showing a hypointense lesion occupying the right nasal cavity. A partially hyperintense area is seen on the upper orbital area and frontal lobe of brain.

  • Fig. 4. Nasoendoscopy findings. Dark browncolored materials are observed nearby ethmoid sinus anterior portion (A). Neighboring mucosa shows thickened and dark color change (B).

  • Fig. 5. Histopathologic findings. Hematoxyline and eosin stain (×400) shows the central necrosis, bacterial colonies. Granulation tissue shows fibrotic change. There were no radiating microfilaments and sulfur granule seen (A, B).

  • Fig. 6. Brain CT was taken after surgery. Hemorrhage was seen in the right frontal lobe (A), and additional CT was taken 7 hours later (B). Hemorrhage and bleeding worsened, causing inflammation and bleeding to spread to the opposite brain (C, D).


Cited by  1 articles

A Case of Extranodal Natural Killer/T Cell Lymphoma Combined With Actinomycosis
Jun Seop Kim, Tae Hoon An, Nam-Kyung Yeo
Korean J Otorhinolaryngol-Head Neck Surg. 2022;65(11):727-733.    doi: 10.3342/kjorl-hns.2022.00703.


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