Actinomycotic Osteomyelitis of the Mandible Diagnosed Using Matrix Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry: A Case Report.

Actinomycosis is a rare, chronic, slowly progressive granulomatous disease caused by filamentous gram-positive anaerobic bacteria from the Actinomycetaceae family (genus Actinomyces). It has become a rare condition because of the widespread use of antibiotics. When clinical symptoms are not typical, diagnosis of this condition becomes difficult. This report describes a case involving an 82-year-old woman who was diagnosed with actinomycotic osteomyelitis of the mandible using matrix assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS). The patient was referred to the authors' department with chief complaints of swelling, multiple fistulae in the left preauricular region, and trismus. The authors performed fine-needle aspiration microbiology (FNAM) and identified Actinomyces oris using MALDI-TOF MS. A diagnosis of actinomycotic osteomyelitis of the mandible was made and the patient was treated with minocycline and extraction of the culprit tooth. The findings from this case have 2 important implications. First, for patients with clinically suspected actinomycosis, bacteriologic examinations should include not only surface swab tests but also FNAM; moreover, communication with the laboratory medical technologist is important to improve detection of the causative organisms. Second, MALDI-TOF MS could be an effective tool for improving the diagnosis and treatment outcomes of actinomycosis.