RARE CASE OF NASOSINUSAL ACTINOMYCOSIS WITH CEREBRAL EXTENSION

Objective: Discuss diagnostic and management difficulties of rhinosinusal actinomycosis with brain extension
Observation: A 48-year-old patient was admitted to the emergency for the management of a diabetic ketoacid coma. The patient was feverish. The examination showed a profuse, foul smelling rhinorrhea, palatal and nasal necrosis with destruction of the nasal cavity soft tissues. The brain and maxillofacial CT scan revealed a partial lysis of the maxillary sinuses, a destruction of the nasal cavities soft tissues and cerebral abcesses. Images and clinical context were strongly suggestive of invasive fungal rhinosinusitis or nocardiosis. Surgical debridement of the maxillary sinuses and the nasal cavities was performed urgently. Biopsies concluded to actinomycosis. Antibiotherapy did not stop the fatal course of the disease.
Conclusion: Rhino-cerebral actinomycosis is a rare, serious and life-threatening disease. It can imitate others mycological or bacterial diseases. In order to not overlook it, the diagnosis must be systematically evoked in case of extensive rhinosinusal necrosis with cerebral extension.
Keywords: Actinomycosis, Actinomycetes, Rhinosinusitis, Brain