J Periodontal Implant Sci.  2012 Dec;42(6):256-260.

Differential diagnosis and treatment of periodontitis-mimicking actinomycosis

• Kim NR
• Park JB
• Ko Y

Abstract

PURPOSE
Actinomycosis is an uncommon chronic granulomatous disease that presents as a slowly progressive, indolent, indurated infiltration with multiple abscesses, fistulas, and sinuses. The purpose of this article is to report on a case of actinomycosis with clinical findings similar to periodontitis.
METHODS
A 46-year-old female presented with recurrent throbbing pain on the right first and second molar of the mandible three weeks after root planing. Exploratory flap surgery was performed, and the bluish-gray tissue fragment found in the interproximal area between the two molars was sent for histopathology.
RESULTS
The diagnosis from the biopsy was actinomycosis. The clinical and radiographic manifestations of this case were clinically indistinguishable from periodontitis. The patient did not report any symptoms, and she is scheduled for a follow-up visit.
CONCLUSIONS
The present study has identified periodontitis-mimicking actinomycosis. Actinomycosis should be included in the differential diagnosis in cases with periodontal pain and inflammation that do not respond to nonsurgical treatment for periodontitis. More routine submissions of tissue removed from the oral cavity for biopsies may be beneficial for differential diagnosis.

Keyword

Actinomycosis; Anti-bacterial agents; Biopsy; Debridement; Periodontitis

MeSH Terms

Abscess
Actinomycosis
Anti-Bacterial Agents
Biopsy
Debridement
Diagnosis, Differential
Female
Fistula
Follow-Up Studies
Granulomatous Disease, Chronic
Humans
Inflammation
Mandible
Molar
Mouth
Periodontitis
Root Planing
Anti-Bacterial Agents

Figure

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  Figure 1 Initial intraoral periapical radiograph of the lower right first and second molars before periodontal treatment.

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  Figure 2 Clinical view at the time of periodontal surgery.

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  Figure 3 The aggregate of gram-positive bacteria (open circle) in periodontal tissue (Gram, ×200).

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  Figure 4 Gram positive colonies of actinomyces (sun-ray pattern, open arrow) and inflammatory cell infiltration (closed arrow) in periodontal tissue (Gram, ×400).

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  Figure 5 Periodic acid-Schiff (PAS) positive colonies of actinomyces in periodontal tissue (PAS, ×400).

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  Figure 6 Silver stain positive colonies of actinomyces in periodontal tissue (Silver, ×400).

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