Tonsillar actinomycosis in a renal transplant patient

Abstract

Actinomyces organisms are Gram-positive, facultative anaerobes that frequently colonize the normal oral cavity and, occasionally, may result in oral-cervicofacial disease. However, tonsillar involvement is very rare. Although this rare infection has been described occasionally in immunocompromised individuals, few cases have been reported following solid organ transplantation. Herein we present a case of tonsillar actinomycosis in a renal transplant patient. Our patient, with a history of recurrent tonsillitis, presented with a 1-month history of sore throat and dysphagia. She underwent a bilateral tonsillectomy because of the papillomatous/necrotic appearance of the tonsils and a suspicion of malignancy. On pathological examination, an inflammatory reaction in association with Actinomyces granules was observed. Postoperatively, the patient was treated with oral doxycycline, and the clinical course was without complication. Although tonsillar actinomycosis is an unusual infection in renal transplant patients, it should be a part of the differential diagnosis of tonsillar disease. Considering the possibility of tonsillar actinomycosis spreading to the cervicofacial region secondary to chronic infection within Waldeyer's ring, it may pose an increased risk for immunocompromised patients, including renal transplant recipients. Because the infection usually responds to medical therapy, this kind of clinical approach may minimize the need for surgical intervention.