Scalp Actinomycosis Presenting as Chronic Discharging Sinuses: A Rare Case Report

Actinomycosis is a rare, chronic granulomatous infection caused by anaerobic, filamentous bacteria of the genus Actinomyces, typically involving the cervicofacial, thoracic, or abdominopelvic regions. Scalp involvement is exceptionally rare and frequently misdiagnosed as a neoplastic or tubercular condition. We report the case of a 47-year-old male tandoor worker with a three-year history of recurrent scalp infections who presented with firm, non-tender swellings over the parietal and occipital scalp, complicated by discharging sinus tracts. MRI revealed ill-defined subcutaneous lesions with no intracranial extension, raising suspicion for inflammatory or neoplastic pathology. Histopathological analysis of both incisional and excisional biopsies revealed basophilic bacterial colonies with radiating filaments surrounded by neutrophils-findings consistent with actinomycosis. Microbiological cultures and species-level identification were not performed due to resource limitations. The patient underwent wide surgical excision followed by transposition flap reconstruction and completed a one-month course of oral doxycycline and amoxicillin-clavulanate. Recovery was uneventful, and no recurrence was observed on follow-up. This case highlights the importance of considering actinomycosis in the differential diagnosis of chronic scalp lesions and underscores the diagnostic value of histopathology in resource-constrained settings and highlights the importance of surgical management in achieving optimal clinical outcomes.