SHM Converge Scientific Abstract ePoster Gallery-A Benign Imitator: Tonsillar Actinomycosis Mimicking Malignancy

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This case report describes a previously healthy woman in her early 40s who presented with persistent unilateral throat pain, left tonsillar swelling, trismus, dysphagia, and weight loss. Initial CT imaging showed a left tonsillar phlegmon/mass with reactive lymphadenopathy, raising strong concern for malignancy. Despite multiple antibiotic courses and four separate biopsies, no cancer was found. Pathology repeatedly showed benign or reactive inflammatory changes until retrospective review of one biopsy identified sulfur granules, confirming tonsillar actinomycosis.<br /><br />Actinomycosis is a rare infection caused by commensal gram-positive bacteria that can become invasive after mucosal disruption. In the tonsil, it may form a firm, fibrotic mass that closely resembles cancer on exam and imaging. Diagnosis is often delayed because cultures are difficult, especially after prior antibiotic exposure, so histopathologic recognition of sulfur granules is critical.<br /><br />After the diagnosis was recognized, the patient was admitted for airway monitoring and treated with broad-spectrum intravenous antibiotics, including piperacillin-tazobactam and daptomycin, with rapid clinical improvement.<br /><br />The report emphasizes that tonsillar actinomycosis can mimic malignancy and lead to repeated invasive procedures, distress, and delayed treatment. Clinicians should consider actinomycosis in patients with a persistent unilateral tonsillar mass that does not respond to standard antibiotics, especially when biopsies are negative for cancer. Careful review of pathology specimens for sulfur granules can prevent unnecessary surgery and allow timely antibiotic therapy, which usually results in excellent recovery.

Asset Subtitle

Ayush Gandhi

Meta Tag

Author List Ayush Gandhi, Cesar Simbaqueba Clavijo, Kodwo Bosomefi Dickson

Category Clinical Vignettes

Concept Tonsillar Actinomycosis

Concept Unilateral Tonsillar Mass

Concept Actinomycosis

Concept Sulfur Granules

Concept Penicillin

Distinguished Non-Finalist

Presenter Organization The University of Texas MD Anderson Cancer Center

Presenting Author Ayush Gandhi

Track Adult

Keywords

tonsillar actinomycosis

unilateral throat pain

tonsillar mass

sulfur granules

malignancy mimic

trismus

dysphagia

reactive lymphadenopathy

biopsy negative

intravenous antibiotics

Tonsillar Actinomycosis

Unilateral Tonsillar Mass

Actinomycosis

Sulfur Granules

Penicillin