Labial Actinomycosis in a Child in University of Uyo Teaching Hospital, Uyo Akwa Ibom State South-South Nigeria: A Case Report
Ikechukwu Agwu Francis *
Department of Medical Microbiology and Parasitology, University of Uyo Teaching Hospital, Uyo, Akwa Ibom, Nigeria.
Ekemini Udo
Department of Paediatrics, University of Uyo Teaching Hospital, Uyo, Akwa Ibom, Nigeria.
Samuel Ibok
Department of Medical Microbiology and Parasitology, University of Uyo Teaching Hospital, Uyo, Akwa Ibom, Nigeria.
Idakari Nweke
Department of Medical Microbiology and Parasitology, Alex Ekwueme Federal University Teaching Hospital, Abakiliki, Ebonyi Nigeria.
Ifeanyi Onwuezobe
Department of Medical Microbiology and Parasitology, University of Uyo, Uyo, Akwa Ibom, Nigeria.
Chinedum Amagwu
Department of Medical Microbiology and Parasitology, Enugu State University Teaching Hospital, Enugu Nigeria.
Augusta Mgbedimma
Department of Medical Microbiology and Parasitology, Veritas University, Abuja, Nigeria.
Anozie Chikezie Enyinnaya
Department of Medical Microbiology, College of Medicine and Health Sciences, Gregory University Uturu, Abia, Nigeria.
Agantem Emmanuel Ekuma
Department of Medical Microbiology and Parasitology, University of Uyo, Uyo, Akwa Ibom, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Background: Actinomycosis is a chronic suppurative infection caused by anaerobic Gram-positive Actinomyces species that normally colonise the oral cavity and digestive and urogenital tracts. Although cervicofacial disease is recognised, isolated labial involvement is uncommon, particularly in children, and may resemble other superficial or neoplastic lesions.
Case Report: An 11-year-old male was referred from a private paediatric clinic with a two-year history of recurrent mouth blisters and ulcers, associated skin lesions, low-grade fever, throat pain, and difficulty swallowing. Examination showed swollen lips and gums, multiple well-circumscribed ulcerative lesions with white-yellow pseudomembranous exudate, areas of necrosis, friable granulation tissue, and black eschar. No sinus tract was observed.
Diagnostic Assessment: Full blood count showed anaemia, neutrophilia, and thrombocytosis; HIV serology was non-reactive, and kidney function test results were normal. Direct Gram staining of lip aspirate demonstrated filamentous branching Gram-positive rods with sulphur granules. Actinomyces israelii could not be isolated because anaerobic diagnostic tools were unavailable. The patient received penicillin therapy and showed complete clinical resolution after eight weeks of treatment.
Conclusion: The case demonstrates the diagnostic value of direct microscopy in labial actinomycosis, particularly where anaerobic culture facilities are limited, and highlights the contribution of clinical microbiology to timely recognition and management of atypical lip lesions.
Keywords: Labial actinomycosis, Actinomyces israelii, paediatric infection, oral actinomycosis, sulphur granules, direct Gram stain