Case report
Actinomycosis of tonsil masquerading as tumour in a 12-year old child

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Abstract

A case of unusual presentation of actinomycosis of tonsil causing massive unilateral enlargement, mimicking a tumor in a 12-year old girl is reported.

Introduction

Actinomycosis is a disease which is not frequently encountered these days because of widespread use of antibiotics. The diagnosis has truly become a medical zebra in the civilised nations.

Actinomycosis occurs in three distinct forms i.e. cervicofacial, abdominopelvic and pulmonothoracic. Cervicofacial is the commonest form because of the presence of organism as commensals in the oral cavity and tonsils [3]. Due to diminished oxidation–reduction potential because of pyogenic aerobic and anaerobic infections, actinomycotic organisms proliferate and directly invade tonsillar tissue [5]. Minor oral trauma, carious teeth or tonsillar fossae offer the organism entry into the subcutaneous tissues and presents as a cervical swelling near the mandible. Authors report a case where actinomycosis caused massive unilateral hypertrophy of tonsil just like a tumour. This is a very unusual presentation of actinomycosis.

Section snippets

Case report

A 12-year old girl reported in the out patient Department of Otolaryngology service with history of progressively increasing difficulty in deglutition and respiration of 3 months duration which used to exacerbate on lying supine. There was no history of fever, cervical lymphadenopathy or recurrent attack of sore throat. On examination there was large, pinkish, irregular, movable mass approximately 6×3 cm in dimension in the oropharynx which was apparently attached to the right tonsil. On

Discussion

The actinomyces in Greek means ‘ray fungus’ and was first reported in 1877 by Bollinger in the cattles [10]. Later Israel et al. (1891) detected the organism from human autopsy and also grew the organism from human lesion under anaerobic environment [7]. The organism was named Actinomyces Israelii in their honour. Although, it was first supposed to be a fungus because of its filamentous appearance but has now been clearly demonstrated to be true bacteria [15].

Diagnosis of actinomycosis is

Summary

Actinomycosis of tonsil is not frequent due to widespread use of antibiotics. We report a 12-year old young girl who presented with progressively increasing difficulty in deglutition and respiration due to massive unilateral enlargement of right tonsil just like a tumour. Excision of right tonsil was carried out histopathological examination confirmed actinomycosis. Postoperative penicillin therapy for 6 weeks completely cured the patient.

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