Etiology

• Actinomyces israelii

Subtypes

• Cervicofacial
• Abdominal
• Pulmonary
• Cutaneous

Predisposing factors

• Surgery and dental procedures
• Previous infection
• Osteoradionecrosis
• Trauma
• Systemic illness

Mnemonic: SPOTS

Clinical

• Indurated woody hard swelling + multiple discharging sinuses Picture
• Pus discharge – Yellow and granular (sulfur granules)
• Chronic low grade persistent infection

Histology

• Sulfur granules
• Filamentous rays in round colonies surrounded by pleomorphs, giant cells and macrophages

Management

• Penicillin + surgical debulking