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Indian Journal of Surgery
Medknow Publications on behalf of Association of Surgeons of India
ISSN: 0972-2068
Vol. 67, Num. 1, 2005, pp. 52-52

Indian Journal of Surgery, Vol. 67, No. 1, January-February, 2005, pp. 52

Images in Surgery

Primary actinomycosis of scalp

Department of Surgery, Fr. Muller Medical College Hospital, Kankanady, Mangalore - 575 002
Correspondence Address:Dept. of Surgery, Fr. Muller Medical College, Kankanady, Mangalore - 575002, Karnataka Email:

Code Number: is05011

A 16-year-old male patient presented with multiple scalp abscesses [Figure - 1] that were drained twice previously, but with recurrence within 2-3 months. His X-ray skull revealed outer table involvement. Drainage and curettage of the abscess cavities was done and contents sent for smear examination, culture and histopathological study. The smear revealed a few Gram-positive cocci, but culture and histopathology demonstrated the actinomycosis species. A thorough evaluation for primary foci in the cervico-thoracic region was negative. He was put on high dose penicillin for 4 weeks. The wounds healed completely and the patient is symptom-free.

Actinomycosis is a disease characterized by indolent abscesses that cross fascial planes, forming chronic sinuses discharging pus with sulphur granules. The causative agents, the bacteria of genus actionomyces, are part of oral flora. The jaw is a characteristic site of infection, but any organ can be affected. The clinical types[1] include Cervico-facial (commonest), Thoracic, and Abdominal (Ileo-caecal). Cervico-facial actinomycosis usually has its origin in the oral cavity and spreads along fascial planes discharging in areas as varied as the tongue, palate or even scalp.[2] the patient usually has poor oral hygiene or a history of predisposing dental work.

Hence any lesion presenting with induration, chronicity and multiple sinuses should be evaluated thoroughly for this entity by bacteriological examination and histopathology irrespective of the site of occurrence.


1.Russell RCG, Williams NS, Christopher JK. Bulstrode - special infections - Bailey and Love's short practice of surgery - 23rd Ed. - International Students Edition; p. 110.  Back to cited text no. 1    
2.Cook G. Actinomycosis - Manson's Tropical Diseases - 20th Ed. India: Saunders / Harcourt; p. 936-7.  Back to cited text no. 2    

Copyright 2005 - Indian Journal of Surgery

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