title: Carotid artery rupture and cervicofacial actinomycosis.
abstract: Cervicofacial actinomycosis is an uncommon, progressive infection caused by bacilli of the Actinomyces genus. Actinomyces are common commensal saprophytes in the oral cavity which may have medical importance as facultative pathogens. Subsequent to local injuries to the oral mucosa, they may penetrate the deep tissues and be responsible for suppurative or granulomatous infections. We herein report a case of a 65-year-old man who underwent surgery followed by chemotherapy and radiotherapy for a tonsillar carcinoma. An ulcerous lesion in the base of the tongue developed and spread to the carotid artery wall. The man died of a massive hemorrhage due to left carotid artery rupture. Postmortem computed tomography angiography performed prior to autopsy allowed the precise localization of the source of bleeding to be detected. Postmortem biochemical investigations confirmed the presence of inflammation associated with local bacterial infection. Histological investigations revealed the rupture of the left carotid artery surrounded by numerous colonies of Actinomyces. Acute and chronic inflammation with tissue necrosis as well as post-actinic, fibrotic changes were also found in the tissues surrounding the ruptured artery wall.
authors: University Center of Legal Medicine, University Institute of Pathology, Centre Hospitalier Universitaire Vaudois, University Hospital Lausanne-Geneva, Rue du Bugnon 21, 1011 Lausanne, Switzerland.
authors: Anne
authors: A
authors: Kummer
authors: Benoît
authors: B
authors: Lhermitte
authors: Micaela
authors: M
authors: Ödman
authors: Silke
authors: S
authors: Grabherr
authors: Patrice
authors: P
authors: Mangin
authors: Cristian
authors: C
authors: Palmiere
mesh_terms: D000197:Actinomycosis, Cervicofacial / Q000150:complications*; D000368:Aged; D000792:Angiography; D001344:Autopsy / Q000379:methods; D002294:Carcinoma, Squamous Cell / Q000382:microbiology / Q000601:surgery*; D020212:Carotid Artery Injuries / Q000150:complications / Q000209:etiology* / Q000382:microbiology; D017809:Fatal Outcome; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000382:microbiology; D012422:Rupture, Spontaneous / Q000150:complications / Q000209:etiology / Q000382:microbiology; D014057:Tomography, X-Ray Computed; D014067:Tonsillar Neoplasms / Q000382:microbiology / Q000601:surgery*; D014313:Trismus / Q000209:etiology