Oral actinomycosis in Crohn’s disease patient: a case report

Case Study

Abstract

Patients with Crohn’s disease may present with lesions in their oral cavity. Oral lesions may be associated with the disease itself representing an extraintestinal manifestation, with nutritional deficiencies or with complications from therapy including infections. Actinomycosis is a slowly progressive bacterial infection caused by Actinomyces spp., anaerobic Gram-positive bacteria. These organisms are normal inhabitants of mucous membranes, especially of the oropharynx, and cause opportunistic infections. We report a case of a 30-year-old male with Crohn’s disease presenting with painful oral aphthous ulcers and swelling of the upper lip. A diagnosis of oral actinomycosis was confirmed by histopathological examination. The patient was treated with infliximab and a regimen of amoxicillin 1 g three times a day. He had a marked response to the treatment after 2 weeks. The plan was to continue amoxicillin for at least 6 months with regular follow-up. Physicians should be aware that actinomycosis may be a cause of oral lesions in Crohn’s disease patient, particularly in immunosuppressed patient. Bacterial cultures and pathology are the cornerstones of diagnosis and should be performed in suspected cases to prevent misdiagnosis.

Graphical abstract

Actinomycosis of bilateral psoas muscle: a case report

Case Study

Abstract

Actinomycosis is an underreported chronic invasive disease caused by Actinomyces spp. In that group of diseases, pelvic actinomycosis is very rare and most of the cases reported in the literature have shown unilateral psoas muscle involvement. We report a 35-year-old woman with a retroperitoneal mass located in the left psoas muscle that makes abdominal tenderness and difficulty in walking. She had a 7-year history of intrauterine device which had been removed one month just before this event. After undergoing two laparotomies to perform a biopsy with undetermined results, she developed a new mass in the right psoas muscle which was similar to the left one. On the third attempt, the histopathology revealed yellow sulfur granules of Actinomyces which reacted positively with periodic acid Schiff and Grocott’s dye. After three months of treatment with Amoxicillin plus Clavulanic acid, her abscesses were completely resolved. Actinomycosis should always be included in the diagnostic list in patients with a pelvic mass and a history of intrauterine device.

Graphical abstract

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