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Case Reports
. 2025 Nov 6;17(11):e96264.
doi: 10.7759/cureus.96264. eCollection 2025 Nov.

The Hidden Threat: Maxillary Hardware-Associated Actinomycosis in Diabetes

Nidha Shapoo  1 , Noella Boma  1
Affiliations
Case Reports

The Hidden Threat: Maxillary Hardware-Associated Actinomycosis in Diabetes

Nidha Shapoo et al. Cureus. .

Abstract

Actinomycosis is a chronic granulomatous infection caused by anaerobic Gram-positive Actinomyces species. While cervicofacial actinomycosis is the most common form, involvement of the maxilla is rare due to its rich vascular supply. Osteomyelitis of the maxilla, caused by actinomycosis, is an uncommon but serious condition that can lead to extensive local destruction and soft tissue involvement in patients with implanted hardware and underlying immunocompromised state. We present the case of a 46-year-old male with poorly controlled type 2 diabetes mellitus and a history of right maxillary hardware placement following a zygomatic arch fracture. He presented with acute right facial swelling, pain, and trismus. Imaging revealed signs of maxillary osteomyelitis and facial cellulitis. Cultures from the surgical debridement grew Actinomyces odontolyticus, Streptococcus epidermidis, Abiotrophia defectiva, and Veillonella parvula. The patient was treated with surgical removal of the infected hardware and a prolonged course of intravenous and oral antibiotics, resulting in full clinical recovery. This case highlights the importance of early recognition and aggressive management of actinomycosis-related osteomyelitis in high-risk patients. Poor dental hygiene, implanted hardware, and systemic immunocompromising conditions such as diabetes mellitus serve as key predisposing factors. Multidisciplinary management and long-term antimicrobial therapy are essential to successful outcomes.

Keywords: actinomycosis cervicofacial; anterior maxilla; diabetes type 2; facial cellulitis; maxillary hardware.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Right-sided facial swelling with erythema.
Figure 2
Figure 2. CT maxillofacial with contrast (sagittal view) showing the right maxillary hardware (yellow arrow), right maxillary sinus opacification (orange arrow), and right facial soft tissue swelling (blue arrow).
Figure 3
Figure 3. CT maxillofacial with contrast (3D view) showing right maxillary hardware (yellow arrow).
Figure 4
Figure 4. Histopathology shows characteristic sulfur granules within the abscess material (H&E stain, x400).
See this image and copyright information in PMC

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