~ 15 ~ Journal of Case Reports and Scientific Images 2021; 3(1): 15-17 E-ISSN: 2708-0064 P-ISSN: 2708-0056 IJCRS 2021; 3(1): 15-17 www.allcasereports.com Received: 14-11-2020 Accepted: 19-12-2020 Amit Sharma Resident, Department of Pathology, INHS Asvini, Colaba, Mumbai, Maharashtra, India Ritu Mehta Consultant Oncopathologist, Department of Pathology, INHS Asvini, Colaba, Mumbai, Maharashtra, India Rakesh Holla Resident, Department of Pathology, INHS Asvini, Colaba, Mumbai, Maharashtra, India Naveen Chawla Head of Department, Department of Pathology, INHS, Asvini Colaba, Mumbai, Maharashtra, India Gurpreet Kaur Consultant Pathologist, Department of Pathology, INHS, Asvini Colaba, Mumbai, Maharashtra, India Corresponding Author: Amit Sharma Resident, Department of Pathology, INHS Asvini, Colaba, Mumbai, Maharashtra, India Actinomycosis lymphadenitis: A rare case report Amit Sharma, Rakesh Holla, Ritu Mehta, Naveen Chawla and Gurpreet Kaur DOI: https://doi.org/10.22271/27080056.2021.v3.i1a.26 Abstract Actinomycosis-associated lymphadenopathy is a rare condition that may clinically simulate malignancy hence early and appropriate diagnosis is necessary for patient management. Keywords: Actinomycosis, lymphadenopathy Introduction Actinomycosis is a subacute-to-chronic bacterial infection. It is characterized by contiguous spread, suppurative, granulomatous inflammation and formation of multiple abscesses along with sinus tracts that may discharge characteristic sulfur granules [1] . In suspicious lesions FNA cytology may be used for diagnosis in refractory lesions. Microbiologic examination also plays a crucial role in the definitive diagnosis. In histopathological examination of lymph nodes, the presence of capsular thickening with reactive germinal centers, intranodal fibrosis, multiple micro abscesses and scattered neutrophil laden macrophages suggests actinomycosis and multiple sections may be needed for identification of specific sulfur granules. Early and appropriate diagnosis is important for early management of patient. Case history A 53 year old male presented with complaints of swelling in right side of neck since three months. Swelling was painless, not associated with fever, trauma, weight loss and was gradually increasing in size. He was a chronic smoker and a known case of diabetes mellitus, hypertension and was on regular medications. On local examination a well-defined, non-tender, hard, fixed soft tissue swelling measuring 5 x 6 cm was palpable at right submandibular region. USG neck was suggestive of necrotic lymph node in right cervical region, level IIa. Patient underwent CECT neck which revealed submandibular lymphadenopathy with enhancing hypodense lesion suggestive of secondary’s from unknown primary. ENT evaluation was essentially normal and no suspicious lesion detected in oral and nasal cavity. Oral hygiene of patient was poor with multiple carries and missing teeth. FNAC from the swelling revealed evidence of haemophagocytosis, thus the possibility of viral/bacterial/fungal infection and malignancy may be considered was opined. After the diagnostic workup, surgical excision of mass was considered. Sialadenectomy of submandibular gland (right) and lymph node excision was done under general anesthesia. The excision biopsy was sent for histopathological examination. On gross examination we received a lymph node measuring 1.5 x 1cm. External surface and cut surface was unremarkable. Haematoxylin and Eosin stained sections from lymph node revealed varied sized lymphoid follicles with dense inflammatory infiltrate comprising of lymphocytes, neutrophils, plasma cells, histiocytes and eosinophils. Few foci show neutrophilic abcesses surrounded by areas of fibrosis. A club shaped cluster of filamentous organism was seen with deposition of radiating eosinophilic material around it as shown in figure 1(a). Sections from right submandibular salivary gland revealed moderate lymphomononuclear infiltrate surrounding benign salivary ducts and glands suggestive of chronic sialdenitis. Special stains were performed. The organism stained positive with gram, grocott methenamine silver (GMS) stain, PAS stain and was negative with ZN satin as shown in figure 1(b, c, d). Based on this diagnosis of actinomycosis was made. Discussion Actinomyces is a gram positive, non-motile filamentous branching, anaerobic bacteria [1] . It occur as a commensal in the oral cavity and gastrointestinal tract of healthy persons [1] .