Abstract
Actinomycosis is a chronic infection caused by Actinomyces, gram-positive, anaerobic bacteria, which are normal constituents of the human oral flora, and frequently affects the cervicofacial region. However, sinonasal actinomycosis has rarely been reported. Actinomycosis of the paranasal sinus mostly occurs in the maxillary sinus; ethmoid sinus actinomycosis is extremely rare. Herein, we report a case of actinomycosis of the ethmoid sinus.
An 81-year-old woman was referred to our department for right nasal obstruction and rhinorrhea. She had previously received antibiotic therapy; however, the symptoms persisted. Nasal endoscopy showed a right nasal polyp, purulent discharge and septum deviation to the left. CT showed an expansive mass in the right ethmoid sinus, deviating the nasal septum. We performed endoscopic sinus surgery, and found sulfur granules in the expanded right ethmoid sinus. Bone destruction was not apparent around the sinus. The histopathological examination revealed actinomycosis. We administered oral amoxicillin for 2 months after the operation. The patient had no recurrence during 13 months of follow-up.
The standard treatment for actinomycosis is long-term antibiotic therapy. On the other hand, in recent reports, cervicofacial actinomycosis without bone involvement has shown a good response to treatment with surgical debridement and short-term antibiotic therapy （2-6 weeks）. In actinomycosis of the paranasal sinus, short-term oral antibiotic therapy with surgical debridement has also been reported to be successful in several papers. For actinomycosis in the paranasal sinus, antimicrobial treatment can be shortened if surgical excision has been performed properly.
