Case Report

Actinomyces Acute Rhinosinusitis Complicated by Subperiosteal Abscess in an Immunocompromised 12-Year-Old: Case Report and Literature Review

Table 2

Cases of paranasal sinus actinomycosis-uncomplicated.

ReferenceAge/SexPresentationMedical HistoryImmune StatusTreatmentOutcome

[1]51/FFacial pain, headache, CT-haziness in the left maxillary, and ethmoid sinuses with calcific density apparent in maxillary sinusUnremarkableNormalESS: maxillary antrostomy, ethmoidectomy, and debridement
Cephalosporin (1 mo) and roxithromycin (3 mo)
Resolution
[1]47/FPostnasal drip, nasal congestion and CT shows haziness in the left maxillary sinus. Calcific density apparent in maxillary sinus CTUnremarkableNormalSee Table 2 Row 1Resolution
[1]52/FPostnasal drip, headache, sneezing, CT shows haziness in left maxillary and ethmoid sinuses. Calcific density apparent in maxillary sinus CTUnremarkableNormalSee Table 2 Row 1Resolution
[1]58/MBloody discharge, CT shows haziness in the left maxillary sinus. Calcific density apparent in maxillary sinus CTUnremarkableNormalSee Table 2 Row 1Resolution
[1]49/FCough, snoring, rhinolalia, CT shows haziness in the right maxillary sinus. Calcific density apparent in maxillary sinus CTUnremarkableNormalSee Table 2 Row 1Resolution
[1]50/FNasal congestion, hyperrhinorrhea, postnasal drip, and CT shows haziness in the left maxillary sinus. Calcific density apparent in maxillary sinus CTOroantral fistula secondary to facial traumaNormalSee Table 2 Row 1

Resolution
[3]41/FSevere aching left-sided headache, R-sided lateral rectus weakness.
Skull x-ray: eroded clival margins and cloudiness of the sphenoid sinuses. Arteriogram: increased blushing in the clival-basi sphenoid area + cavernous sinus thrombosis.
Electroshock therapy,
depression, and pneumonia (2x)
NormalTransseptal sphenoidotomy
Transethmoidal + antral sphenoidotomy
IV penicillin → phenoxy methyl penicillin (3 mo.)
Isoniazid + tetracycline (4 mo.)
Clival cortex restoration, sinus aeration, and sphenoid sclerosis on CT at 3 mo. follow-up.
[9]50/FRight facial pain and tenderness, maxilla numbness, ear fullness, pressure, hearing loss. CT showed opacification of right maxillary sinus.Dental extractionNot reportedRight middle turbinectomy, maxillary antrostomy, anterior and posterior ethmoidectomy. Endoscopy
 + debridement
Penicillin VK (7 wks)
Doxycycline
Resolution
[14]42/FLeft maxillary tenderness, mucosal inflammation in the left middle meatusOsseointegrated dental implants, oroantral fistula, and refractory sinusitis
NormalLeft Caldwell-Luc for maxillary sinus debridement
Endoscopic ethmoidectomy
IV penicillin (3 wks), Oral penicillin (3 mo.)
Resolution
[20]67/FFacial swelling, painRefractory sinusitisNormalPenicillin (6 mo.)Resolution
[21]32/FNasal congestion, headache. CT-intrasinus hyperattenuating tissue in the sphenoid sinus, suggesting chronic fungal sinusitisOtorrhea R radical mastoidectomy + empirical systemic + otic antibioticsNot reportedEndoscopic exploration and drainage of the sphenoid sinus.Not reported
[22]25/FLeft cheek discomfort (8 months), plain film, and CT showed a metallic foreign body in the left maxillary sinusChronic allergic rhinosinusitis, dental prosthesis extraction 3yrs priorNot reportedLeft Caldwell-Luc → maxillary sinus irrigation with an aqueous solution of 1% gentian violet and a specimen sent to pathology
Oral amoxicillin/clavulanate +  deflazacort (2 wks)
Amoxicillin/clavulanate (3 mo)
Resolution
[23]47/FMild chronic pain in the left buccal region with a tender lesion and slight swelling. CT-left maxillary and partial ethmoid opacification and calcified fragment close to the natural ostium.UnremarkableNormalMaxillary antrostomy + anterior ethmoidectomy with a sampling of caseous material at maxillary os
Clarithromycin for 6 months
Resolution
[24]33/FRight nasal obstruction, intermittent epistaxis, purulent rhinorrhea, and headaches for 1 year.
CT-round and linear calcification with central lucency resulting in mucosal thickening of the right inferior turbinate and nasal septum with haziness in the right maxillary sinus.
UnremarkableNormalESS
Cefdinir 100 mg TID and w mupirocin nasal irrigations
Resolution
[25]58/FFever, left-sided facial pain, swelling, and redness for 3 days. CT- heterogeneous soft tissue density filling left maxilla and ethmoids, with no clear bony erosions.Diabetes, past episodes of discharging sinuses over the abdominal wall and hip.
Tooth extraction and dental implantation 2 years prior to symptoms
ImmunocompromisedESS-a sampling of the maxillary and ethmoid sinus
Amoxicillin/clavulanate (2 wks)
Endoscopy at follow-up showed granular mucosa with yellow spots in the postoperative cavity.
Oral amoxicillin TID (3 months)
Resolution

CT: computed tomography, ESS: endoscopic sinus surgery, IV: intravenous, and TID: three times daily.