Lingual Actinomycosis – A Rare Report of the Ray Fungus

Actinomycosis is an uncommon chronic suppurative infection caused by a Gram-positive anerobic bacterium Actinomyces israelii or Actinomyces gerencseriae. Lingual actinomycosis is a rare form of actinomycosis with a prevalence of 3%. We report a case of a 16-year-old female, with an acute-onset painful ulcer with a yellowish-white slough over the left lateral border of the tongue preceded by a tongue swelling. There was a history of tongue bites before the onset of swelling. Histopathological examination was suggestive of lingual actinomycosis. The lesions resolved 3 weeks after treatment with amoxicillin and clavulanic acid combination, but the patient was advised to complete the 6-week antibiotic course. The patient did not have any new ulcers in the follow-up. The tongue is inherently resistant to bacterial adherence and infection, but a break in the integrity of the skin or the presence of devitalized tissue usually aids in the invasion of the organism into deeper structures. The disease is usually localized to the tongue but can also spread to jaws (osteomyelitis of jaws), lungs, heart, and brain and can lead to death. Although antibiotic therapy remains the mainstay of treatment, surgical excision has a profound positive effect on the antimicrobial treatment. It is worth considering actinomycosis as a possibility in suppurative, granulomatous, and suspicious lesions of the tongue.