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Case report
Bony cystic lesion with associated submandibular lymphadenopathy on a background of breast carcinoma: an unexpected case of cervicofacial actinomycosis
  1. Lwazi Sibanda1,
  2. Emma Wates2 and
  3. James Higginson3
  1. 1Department of Oral and Maxillofacial Surgery, Worcestershire Acute Hospitals NHS Trust, Worcester, Worcestershire, UK
  2. 2University of Bristol Medical School, Bristol, UK
  3. 3Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital Birmingham, Edgbaston, UK
  1. Correspondence to Emma Wates; emma.wates{at}


Actinomycosis is an uncommon, chronic suppurative granulomatous infection and needs to be considered as a differential diagnosis. A 56-year-old woman with a background of type 2 diabetes mellitus and breast carcinoma was referred to the Oral and Maxillofacial Surgery 2-week wait clinic, regarding a tender sublingual mass and firm erythematous swelling in the right submandibular and submental region. This was slowly progressive and had not responded to oral co-amoxiclav. An orthopantomogram showed a well-defined radiolucency and smaller radiolucent lesions throughout the edentulous right body of the mandible. A contrast-enhanced CT confirmed a right submandibular abscess communicating with cavitating lesions. The differentials included osteomyelitis, bony metastases, multiple myeloma or other cystic lesions. The patient underwent incision and drainage of the abscess, alongside biopsies, and intravenous co-amoxiclav was given. Microbiology cultures confirmed the presence of Actinomyces israelii and a diagnosis of cervicofacial actinomycosis with mandibular osteomyelitis. The patient was successfully treated with prolonged antibiotics.

  • oral and maxillofacial surgery
  • dentistry and oral medicine
  • surgical diagnostic tests
  • infections
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  • Twitter @jimhigginson

  • Contributors LS wrote the paper and conducted the literature review and EW and JH revised the draft paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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