Case Report

Actinomycotic Osteomyelitis of the Maxilla in a Patient on Phenytoin


Actinomycosis is caused by Actinomyces species and is relatively rare in humans. Because of the special collateral blood flow, osteomyelitis is less common in the maxilla than the mandible. Although there are few case reports for jaw osteomyelitis, actinomycotic osteomyelitis associated with phenytoin therapy has not been reported before. The data show that antiepileptic drugs induce suppression of the immune system. This report presents a rare case of a 58-year-old man on phenytoin with actinomycotic osteomyelitis, and reviews the relevant literature.

1. Girgis S, Tvedt D, Cheng L. Doctor, here is my palate: rare occurrence of subtotal maxillary osteomyelitis. Br J Oral Maxillofac Surg. 2015 Jan;53(5):467-9.
2. Arunkumar JS, Naik AS, Prasad KC, Santhosh SG. Role of nasal endoscopy in chronic osteomyelitis of maxilla and zygoma: a case report. Case Rep Med. 2011 Aug;2011:802964.
3. Gannepalli A, Ayinampudi BK, Baghirath PV, Reddy GV. Actinomycotic osteomyelitis of maxilla presenting as oroantral fistula: A rare case report. Case Rep Dent. 2015 Sep;2015:689240.
4. Peravali RK, Jayade B, Joshi A, Shirganvi M, Bhasker Rao C, Gopalkrishnan K. Osteomyelitis of maxilla in poorly controlled diabetics in a rural Indian population. J Maxillofac Oral Surg. 2012 Jan;11(1):57-66.
5. Habib A, Sivaji N, Ashraf T. Maxillary osteomyelitis: A rare entity. Case Rep Otolaryngol. 2016 Aug;2016:9723806.
6. Stenhouse D, MacDonald DG. Low grade osteomyelitis of the jaws with actinomycosis. Int J Oral Surg. 1974 Dec;3(2):60-4.
7. Meethal AC, Pattamparambath M, Balan A, Kumar NR, Sathyabhama S. Actinomycotic osteomyelitis of the maxilla - A delusive presentation. J Clin Diagn Res. 2016 Jul;10(7):Zj01-3.
8. Bartkowski SB, Zapala J, Heczko P, Szuta M. Actinomycotic osteomyelitis of the mandible: review of 15 cases. J Craniomaxillofac Surg. 1998 Feb;26(1):63-7.
9. Agarwal P, Chug A, Kumar S, Jain K. Palatal actinomycosis osteomyelitis–Complication of
impacted tooth in a diabetic. Spec Care Dentist. 2019;May 39(3):319-23.
10. Bano S, Parveen R. Differential diagnosis of osteomyelitis of maxilla in a long standing diabetic patient-A rare case report. Contemp Clin Dent 2019;Jun13(1):974-3979.
11. Baldawa P, Shirol P, Kulkarni D, Koshti S, Mishra N. Actinomycotic osteomyelitis of palate masquerading periapical pathology: A rare case report Indian J Dent Res. 2018;Jun29(2):247.
12. Garg R, Schalch P, Pepper JP, Nguyen QA. Osteomyelitis of the hard palate secondary to actinomycosis: a case report. Ear, Nose Throat J. 2011 Mar;90(3):E11-2.
13. Yamada M, Hayatsu Y, Mizugaki Y, Shinozaki F. A case of osteomyelitis of the maxilla caused by actinomycosis. Japan J Oral Maxillofac Surg. 2000 Jun;46(6):375-7.
14. Sezer B, Akdeniz BG, Günbay S, Hilmioğlu-Polat S, Başdemir G. Actinomycosis osteomyelitis of the jaws: Report of four cases and a review of the literature. J Dent Sci.2013 Feb;12(3):301-7.
15. de Oliveira Antunes L, da Silveira Borges R, de Freitas WV, de Souza SR, Corrêa DG. Osteomyelitis of the maxilla caused by Actinomyces sp. Radiol Bras. 2018 Sep-Oct;51(5):340.
16. Hovi L, Saarinen UM, Donner U, Lindqvist C. Opportunistic osteomyelitis in the jaws of children on immunosuppressive chemotherapy. J Pediatr Hematol Oncol. 1996 Feb;18(1):90-4.
17. Yenson A, DeFries HO, Deeb ZE. Actinomycotic osteomyelitis of the facial bones and mandible. Otolaryngol Head Neck Surg. 1983 Apr;91(2):173-6.
18. Andrzejczak D. Epilepsy and pro-inflammatory cytokines. Immunomodulating properties of antiepileptic drugs. Neurolo i Neurochir Pol. 2011 May;45(3):275-85.
19. Ettore B, Simon SH.Antiepileptic drugs and the immune system.Epilepsia.2011 May;52(s3):40-44
20. Basaran N,Kansu E, Hincal F.Serum immunoglobulins,complement levels and lymphocyte subpupulation in phenytoin-treated epileptic patients. Immunopharmacol immunotoxicol.2008 Sep; 11(2-3):335-46.
21. Sorrell TC, Forbes IJ. Depression of immune competence by phenytoin and carbamazepine. Studies in vivo and in vitro. Clin Exp Immunol. 1975 May;20(2):273-85.
22. Basta-Kaim A, Budziszewska B, Lasoń W. Effects of antiepileptic drugs on immune system. Przeglad lekarski. 2008 Jan;65(11):799-802.
IssueVol 19 (Continuously Published Article-Based) QRcode
SectionCase Report
Actinomyces Osteomyelitis Maxilla Phenytoin Immune System

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How to Cite
Aghahosseini F, Ghasemzadeh E, Mahdavi N. Actinomycotic Osteomyelitis of the Maxilla in a Patient on Phenytoin. Front Dent. 2022;19.