Case of maxillary actinomycotic osteomyelitis, a rare post COVID complication-case report

Abstract

Introduction: and Importance: Maxillary actinomycosis is a persistent, very rare disease produced by Actinomyces species which may include only soft tissue or bone or the two together. Actinomycotic osteomyelitis of maxilla is very infrequent when compared to mandible.

Case presentation: Here we are conferring a case of an elderly male patient who had history of COVID-19 infection 4 months ago, with constant complaint of non-remitting vague pain in the region of maxilla with tooth loosening and extractions. He was given a provisional diagnosis of chronic osteomyelitis of maxilla which was later on proved by histopathology as actinomycotic osteomyelitis.

Clinical discussion: A saprophytic fungus causes mucor mycosis, and it is quite unusual. Strawberry gingivitis is one of the signs and symptoms. Mucormycosis and post-covid oral maxillofacial problems can be improved with early diagnosis. Oral Mucormycosis should be suspected in individuals with weakened immune systems, uncontrolled diabetes or post-covid instances. Surgery and adequate antibiotic treatment are necessary to treat actinomycosis. Infection may return after a period of inactivity, so long-term follow-up is necessary.

Conclusion: We conclude a positive causal association between COVID-19 and actinomycosis. Maxillary osteomyelitis, a very rare infection, and in our case, the causative organism was Actinomyces Patients who have been infected should be tested for Actinomycin, which may masquerade as a head and neck illness.

Keywords: Actinomycosis; CT scan; MRI; Osteomyelitis.

Fig. 1

“Actinomycosis involving the maxilla in a 56-year-old man. Axial contrast-enhanced CT image (bone window) shows irregular erosive bone destruction with irregular fragments of dense bone in the center of lysis, findings indicate chronic osteomyelitis”.

Fig. 2

Coronal CT image showing lytic lesion in maxilla with central sequestrum.

Fig. 3

Showing MRI with contrast showing marginal enhancement of the maxilla with central necrosis. No significant soft tissue component and cervical lymphadenopathy is noted.

Fig. 4

Gram stain showing filamentous bacteria.