Primary Cutaneous Actinomycosis of Lower Extremity: A Rare Case Report

Introduction ctinomycosis was first described as a clinical entity over 100 years ago: in fact, the first case of actinomycosis, in man, was described by Von Langebeck, in 1845, and it was attributed to a fungus. Israel and Ponfick, in 1891, defined the anaerobic nature of actinomyces and isolated it in man. Actinomyces species are members of the endogenous flora of mucous membranes, and are frequently cultured from the gastrointestinal tract, bronchi, and female genital tract. Actinomycosis is a slowly-progressive infection caused by filamentous, grampositive, anaerobic (or facultatively anaerobic) bacilli of the Actinomyces genus. A. israelli is the most frequent pathogen involving human infection. Actinomycosis is a rare, suppurative, granulomatous disease that may involve several organs. It is more common in males (3:1) and in immunocompromised patients. There are three classic patterns of actinomycosis; i) cervico-facial, involving the jaw extending into the neck, ii) thoracic, and iii) abdominopelvic. Cutaneous involvement is well documented and it is usually secondary to local extension or probably to hematogenous spreading from various sites. Primary actinomycosis of extremity is very rare with less than 50 case reports in the literature. Preoperative diagnosis is usually difficult with the majority of cases being diagnosed after the histological and bacteriological examination of the resected specimen. We herein report on a rare case of cutaneous actinomycosis in the lower extremity presenting as a soft tissue mass.