Jemds.com Case Report J Evolution Med Dent Sci / eISSN - 2278-4802, pISSN - 2278-4748 / Vol. 9 / Issue 37 / Sept. 14, 2020 Page 2761 Lumpy Bumpy Weepy Face - A Rare Case Report of a Frequently Misdiagnosed Disease Ramachandran Ramakrishnan 1 , Dhivya Sundararajan 2 , Shivasekar Ganapathy 3 , Balaji Durairaj 4 , Murali Narasimhan 5 1 Department of Dermatology, Venereology and Leprosy, SRM Medical College & Hospital, Kattankulathur, Potheri, Tamil Nadu, India. 2 Department of Dermatology, Venereology and Leprosy, SRM Medical College & Hospital, Kattankulathur, Potheri, Tamil Nadu, India. 3 Department of Pathology, SRM Medical College & Hospital, Kattankulathur, Potheri, Tamil Nadu, India. 4 Department of General Surgery, SRM Medical College & Hospital, Kattankulathur, Potheri, Tamil Nadu, India. 5 Department of Dermatology, Venereology and Leprosy, SRM Medical College & Hospital, Kattankulathur, Potheri, Tamil Nadu, India. Infectious clinical conditions that can present with swellings and sinuses more commonly, include cutaneous tuberculosis, and subcutaneous and deep fungal infections. One of the differentials that should be considered in such a scenario is actinomycosis. Actinomyces are filamentous gram-positive bacteria that are facultative anaerobes which can form endospores. The individual bacterium is rod shaped filamentous organism. After its discovery in 1890, a misconception was that it is a mycosis that affected individuals who chewed grass or straw. The pathogen is still known as the ‘great masquerader’. 1 Many entities can mimic cutaneous mycobacterial infections and deep cutaneous mycosis. One such great mimicker is actinomycosis – a bacterial infection caused by Actinomyces israelii. Though it is sensitive to many antibiotics, the duration of treatment for effective clearance of the lesions is long. PRESENTATION OF CASE A previously healthy 51-year-old female agricultural worker presented with multiple nodular lesions over the face and scalp with pus discharge from some of the nodules, over a period of 1 year. There was no history of trauma, dental procedures or fever prior to the onset of these lesions. Gradually over the last year, she experienced progression of the lesion in size and number and she felt a vague local pain. Subsequently she developed serous and pus discharge on and off from few lesions. In the past 3 months, she had gradual worsening of restriction in opening her mouth. Past medical history and Family history was negative for significant illness or similar complaints. On clinical examination, she had multiple, well defined, indurated, hyperpigmented subcutaneous firm nodules (Fig. 1A) over the forehead & few plaques with a single active discharging sinus (Fig. 1B) in right pre auricular region. Multiple puckered scars (Fig. 1B) were noted on the right pre auricular area & right side of forehead. Restricted mouth opening (able to insert 2 fingers) was noted. Additionally, she had 0.5 to 1 cm, multiple, tender, firm, discrete and mobile submandibular, sub mental and pre auricular lymph nodes on the right side. Oral mucosa was normal. Corresponding Author: Dr. Murali Narasimhan, Head of Department, Department of DVL, SRM Medical College and Hospital And Research centre, Potheri, Tamilnadu, India. E-mail: leecutis@gmail.com DOI: 10.14260/jemds/2020/599 How to Cite This Article: Ramakrishnan R, Sundararajan D, Ganapathy S, et al. Lumpy bumpy weepy face - a rare case report of a frequently misdiagnosed disease. J Evolution Med Dent Sci 2020;9(37):2761-2763, DOI: 10.14260/jemds/2020/599 Submission 01-06-2020, Peer Review 25-07-2020, Acceptance 03-08-2020, Published 14-09-2020. Copyright © 2020 JEMDS. This is an open access article distributed under Creative Commons Attribution License [Attribution 4.0 International (CC BY 4.0)] INTRODUCTION