Actinomycotic Osteomyelitis of the Maxilla in a Patient on Phenytoin

Abstract

Actinomycosis is caused by Actinomyces species and is relatively rare in humans. Because of the special collateral blood flow, osteomyelitis is less common in the maxilla than the mandible. Although there are few case reports for jaw osteomyelitis, actinomycotic osteomyelitis associated with phenytoin therapy has not been reported before. The data show that antiepileptic drugs induce suppression of the immune system. This report presents a rare case of a 58-year-old man on phenytoin with actinomycotic osteomyelitis, and reviews the relevant literature.

Keywords: Actinomyces; Immune System; Maxilla; Osteomyelitis; Phenytoin.

Fig. 1

Unilateral periodontal ligament widening in the cropped view of OPG. Loss of teeth around the fallen tooth and a mass in the form of an erythematous nodules

Fig. 2

Perforation of the buccal and lingual cortical plates on cropped view of cone-beam computed tomography scan

Fig. 3

H&E-stained section showing (A) necrotic bone trabeculae enclosing large colonies of actino-mycotic organism (×40). (B) Characteristic feature of an actinomycotic colony with basophilic core and eosinophilic peripheral portion (×40). (C) Polymorphonuclear leucocytes surrounding actinomycotic colonies (×400). (D) Necrotic thickened bone trabeculae with sclerosis and prominent reversal lines that exhibit loss of osteocytes from their lacunae (×100)