Dual pathology: cervicofacial actinomycosis and nicorandil-induced oral ulceration.
BACKGROUND
Oral ulceration has many causes and is a common presenting symptom in otolaryngology.


METHODS
This article presents an unusual case of dual pathology oral ulceration in an elderly patient. Oral malignancy was initially suspected, but the history, examination and investigation showed that the oral ulceration was caused by actinomycosis infection and by nicorandil use.


CONCLUSIONS
Cervicofacial acinomycosis is a rare, suppurative bacterial disease in which abscesses can form in the tissues and break through the skin, creating pus-discharging lesions. Nicorandil is a potassium channel blocker used in the treatment of ischaemic heart disease. It has been recently recognised as a cause of persistent ulcerative stomatitis.


CONCLUSIONS
This case highlights the importance of a high index of suspicion for unusual and reversible causes of oral ulceration, and of dual pathology as a cause. Such vigilance enables early recognition and treatment of potentially reversible conditions.
Cupples
H E V
HE
Ear, Nose & Throat - Regional Head & Neck Cancer Centre, The Royal Group of Hospitals and Social Services Trust, Belfast, Northern Ireland, UK. victoria.cupples@btinternet.com
McGahey
D T
DT
D000197:Actinomycosis, Cervicofacial / Q000150:complications* / Q000000981:diagnostic imaging; D000368:Aged; D002908:Chronic Disease; D005260:Female; D006801:Humans; D020108:Nicorandil / Q000009:adverse effects*; D019226:Oral Ulcer / Q000209:etiology*; D014057:Tomography, X-Ray Computed; D014665:Vasodilator Agents / Q000009:adverse effects*
D014665:Vasodilator Agents; D020108:Nicorandil