Cutaneous actinomycoses leading to brain invasion: A case report

Abstract

Rationale: Central nervous system (CNS) actinomycosis is rare, spreading hematogenously from distant infections. Cutaneous actinomycosis with skull/meninges spread is especially unusual.

Patient concerns: A 57-year-old man presented with complaints of discharge from the back of his scalp for six months, an ataxic gait, and bilateral upper and lower limb weakness and numbness over the past 4-5 months.

Diagnosis: CNS actinomycosis.

Interventions: Intravenous injection of ceftriaxone followed by oral amoxicillin-clavulanic acid therapy.

Outcomes: The patient was able to walk without support, with complete resolution of sinus discharge.

Lessons: In patients presenting with discharging sinuses especially when accompanied by CNS symptoms, actinomycosis should be considered as a differential, along with tuberculosis, non-tubercular mycobacterial infection, and aspergillosis. Microbiological confirmation should be attempted wherever possible, for accurate diagnosis and treatment, as clinic-radiological picture alone may not differentiate these infections, as treatment of each is diametrically opposite and patients can be cured with timely and appropriate treatment.

Keywords

Actinomycosis / CNS invasion / Cutaneous abscesses / Osteomyelitis / Pachymeningitis

References

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