Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Art & Psychiatry
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Conference Oration
Conference Summary
Continuing Medical Education
Cosmetic Dermatology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
Editor Speaks
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Miscellaneous Letter
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News & Views
Observation Letter
Observation Letters
Original Article
Original Contributions
Pattern of Skin Diseases
Pediatric Dermatology
Pediatric Rounds
Presedential Address
Presidential Address
Presidents Remarks
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Study Letter
Study Letters
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapy Letter
Therapy Letters
View Point
What’s new in Dermatology
View/Download PDF

Translate this page into:

Letter to the Editor - Case Letter
doi: 10.4103/ijdvl.IJDVL_685_16
PMID: 28540876

Actinomycotic osteomyelitis

Yashwant Ingle1 , Roopa Madalli2 , Mamatha G. S. Reddy2 , Supriya Kheur2 , Manjusha Ingle3
1 Dental Wing, Yashwantrao Chavan Memorial Hospital, Pune, Maharashtra, India
2 Department of Oral Pathology and Microbiology, Dr. D. Y. Patil Vidyapeeth's Dr. D. Y. Patil Dental College and Hospital, Pune, Maharashtra, India
3 Department of Oral Medicine and Radiology, Dr. D. Y. Patil Vidyapeeth's Dr. D. Y. Patil Dental College and Hospital, Pune, Maharashtra, India

Correspondence Address:
Supriya Kheur
Dr. D. Y. Patil Vidyapeeth's Dr. D. Y. Patil Dental College and Hospital, Pimpri, Pune - 411 018, Maharashtra
How to cite this article:
Ingle Y, Madalli R, Reddy MG, Kheur S, Ingle M. Actinomycotic osteomyelitis. Indian J Dermatol Venereol Leprol 2017;83:468-469
Copyright: (C)2017 Indian Journal of Dermatology, Venereology, and Leprology


Actinomycosis is a rare, chronic disease caused by a group of anaerobic, Gram-positive bacterium, Actinomyces israelii. A. israelii accounts for 52% of the infections, whereas Actinomyces viscosus, Actinomyces odontolyticus, Arachnia propionica and Actinomyces meyeri contribute to 40%, 5%, 2%, 2% and 1%, respectively.[1] It is a non-acid fast, filamentous branched bacterium. Cope in 1938 suggested that the infection may be anatomically classified as cervicofacial (i.e. lumpy jaw), thoracic or abdominal. The most common presentation is cervicofacial, which accounts for over half of the reported cases.[2] Although rarely seen in day-to-day dental practice, due to its aggressive and locally destructive nature, actinomycosis of the oral cavity is a highly significant condition.[3]

Mucosal discontinuity is needed to lead to infection. We report a case of actinomycotic osteomyelitis leading to extensive destruction of mandibular right anterior region following tooth extraction.

A 28-year-old man reported to the dental outpatient department in Yashwantrao Chavan Memorial Hospital, Pimpri-Chinchwad, Pune, Maharashtra, India, with the chief complaint of painful swelling on the lower right premolar and molar region. On taking a detailed past history, the patient explained that he was diagnosed for noma for which surgical intervention was done by a local doctor. Later, he got his mobile tooth 46 extracted and skin graft was placed elsewhere. After 15 days of extraction, swelling developed in the left premolar region for which he reported to the dental outpatient department in a medical hospital. On extraoral examination, a diffuse swelling extending from the lower right corner of the mouth to the left corner of the mouth was noticed without marginal induration. The swelling was tender on palpation. Intraoral examination revealed pieces of white necrotic bone (sequestrum) and swelling in the buccal mucosa [Figure - 1]. The mucosa over the swelling was reddish showing sinus tract with purulent exudate on the alveolar ridge at the site of tooth extraction. Right submandibular regional lymphadenopathy was seen. Radiographic examination revealed mottled bone appearance.

Figure 1: Ulcer on the anterior alveolar ridge with necrotic bony spicules

The swelling was then incised under local anesthesia in aseptic conditions. Caseous material was observed with purulent discharge. Pus culture showed the presence of nonsporing Gram-positive rods. Biopsy was taken and the tissue was histopathologically analyzed. Hematoxylin and eosin stained sections revealed bone with empty lacunae indicating sequestrum. Numerous actinomycotic colonies consisting of club-shaped filaments with basophilic central core and eosinophilic peripheral portion were seen with some neutrophils [Figure - 2] and [Figure - 3]. The histological appearance of the biopsied material was consistent with that of osteomyelitis in association with infection by Actinomyces organisms. Based on this, a diagnosis of actinomycotic osteomyelitis was given. Incision and drainage was performed and amoxicillin along with clavulanic acid 625 mg orally twice daily was prescribed for 7 days. The patient was recalled after a week and continued the medication for another 2 weeks. The patient reported after 2 months with no complaints.

Figure 2: Necrotic bone and actinomycotic colonies in the marrow spaces (H and E, ×100)
Figure 3: Necrotic bone with empty lacunae and actinomycotic colonies (ray fungus) (H and E, ×400)

Osteomyelitis due to Actinomyces has been reported infrequently. The spread of Actinomyces by hematogenous route with intraosseous granuloma formation and minimal subperiosteal bone reaction has been reported by Bala et al.[4] In cervicofacial actinomycosis which is the most frequent the mandible is more commonly involved than maxilla (4:1). It requires a break in the integrity of the mucous membranes and the presence of devitalized tissue to invade deeper body structures and to cause disease which occurs through oro-maxillofacial trauma, dental extractions, dental caries or most probably through any dental intervention as the causative organism Actinomyces is not virulent.[2]

Mandibular actinomycotic osteomyelitis is usually underappreciated by many clinicians in their assessment of head and neck infections. Most of the cases are traced to an odontogenic source with periapical tooth abscess and posttraumatic or surgical complication as the key antecedent events.[5] Hence, a biopsy should be performed on any persistent periapical lesion with osteomyelitis even though a chronic draining sinus or cervicofacial abscess does not exist. The most important clinical relevance is to send the discharge for microbial examination rather than only biopsy.

Even though the proper surgical incision and drainage and the administration of antibiotics caused the lesion to regress, sometimes, it can prove potentially fatal. Hence, this disease needs to be considered frequently in the diagnosis of head, neck and intraoral infections.

In the background of debilitating bacterial infections, a vigorous antimicrobial regimen should be followed before undertaking any surgical procedure. Actinomycotic osteomyelitis is a chronic specific suppurative osteomyelitis which is not refractory to treatment. In our case, the patient developed actinomycotic osteomyelitis after tooth extraction as a postprocedural complication. As actinomycotic osteomyelitis develops in patients with poor host immune response, the morbidity and mortality rate should be reduced with proper management.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

Ozaki W, Abubaker AO, Sotereanos GC, Patterson GT. Cervicofacial actinomycoses following sagittal split ramus osteotomy: A case report. J Oral Maxillofac Surg 1992;50:649-52.
[Google Scholar]
Belmont MJ, Behar PM, Wax MK. Atypical presentations of actinomycosis. Head Neck 1999;21:264-8.
[Google Scholar]
Crossman T, Herold J. Actinomycosis of the maxilla – A case report of a rare oral infection presenting in general dental practice. Br Dent J 2009;206:201-2.
[Google Scholar]
Bala S, Narwal A, Gupta V, Duhan J, Goel P. Actinomycotic osteomyelitis of mandible masquerading periapical pathology. J Oral Health Comm Dent 2011;5:97-9.
[Google Scholar]
Freeman LR, Zimmermann EE, Ferrillo PJ. Conservative treatment of periapical actinomycosis. Oral Surg Oral Med Oral Pathol 1981;51:205-8.
[Google Scholar]

Fulltext Views

PDF downloads
Show Sections