Hypopharyngeal and Laryngeal Actinomycosis Mimicking Malignancy—A Case Report

Actinomycosis is a rare bacterial infection caused by Actinomyces, a group of Gram-positive anaerobic bacilli. These bacteria are a normal component of human flora; however, they can become pathogenic in susceptible hosts by entering through mucosal defects and disseminating submucosally to involve the surrounding tissue. Cervicofacial actinomycosis is the most common presentation; however, Actinomyces can rarely involve other aspects of the head and neck. Actinomycosis in this region is often mistaken for other disease processes, given its tendency to mimic other pathologies. We present a unique case of a 72-year-old male presenting with acute respiratory compromise due to submucosal actinomycosis of both the hypopharynx and the larynx requiring an emergent surgical airway. Many aspects of this patient's presentation were highly suspicious of malignancy, including medical history, presenting symptoms, flexible laryngoscopy findings, CT results, and intraoperative appearance of the lesions. Actinomycosis should remain on the differential in patients with a submucosal laryngeal mass with clinical and radiographic evidence of extra laryngeal extension, especially in patients with a history of mucosal trauma, poor dentition, or an immunocompromised state. Multiple biopsies should be obtained, with definitive surgical treatment planning pending final pathology.