A 78-Year-Old Man With a Lingual Ulcerative Lesion

Talib A. Najjar, DMD, MDS, PhD; Prabhjot Singh, DDS

Disclosures

July 21, 2016

Surgical management of actinomycosis includes excision/debridement of abnormal or devitalized tissue, such as infected masses and curettage of osteomyelitic bone lesions. Drainage of any existing abscesses or fistula tracts is also necessary, when present. Surgical treatment alone, however, is not sufficient for treatment.

Figure 4.

Depending on the type of infection, prolonged antibiotic therapy is the cornerstone of management. Classically, these infections are treated with penicillin-type antibiotics; the duration of therapy is targeted to the patient's clinical condition and response to treatment. Penicillin resistance is uncommonly observed. Certain antibiotics (namely, metronidazole, aminoglycosides, cotrimoxazole, or cephalexin) have no role in treating this infection. Limited case reports have reported success with fluoroquinolones, such as levofloxacin or moxifloxacin. This infection may respond to some second- or third-generation cephalosporin, macrolide, or tetracycline antibiotics.[1,2,4]

The patient in this case was started on a course of oral penicillin VK at 500 mg every 6 hours for 3 weeks. Because it was felt that the blade implant and associated prosthesis could be harboring actinomycotic colonies and could seed more bacteria in the left lateral tongue, it was decided to remove the blade implant along with the prosthesis supported by the implant. The patient was followed for approximately 1 month, at which time total resolution of the lesion was observed (Figure 4).

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