酒精性肝硬化併下頜骨放線菌感染：病例報告

Alcoholic Liver Cirrhosis with Mandibular Actinomycosis: A Case Report

放線菌是人體口腔固有的細菌之一，其致病性低，因此須藉助其他細菌共同感染。患者常是免疫力低下且有口腔黏膜的缺損。較嚴重的話會合併少見的骨質感染。本文報告一名44 歲酒精性肝硬化男性病患因近十多日在右側下頜區有一無痛性腫塊而前來治療。就診前曾因嚴重齲齒而拔除右側下大臼齒。局部所見右側下齒槽有肉芽生成合併膿樣分泌物，右側下頜緊臨下頜骨處有固着性硬塊，皮膚表面呈深色且有壞死分泌物滲出。影像學檢查發現右下齒槽骨質腐蝕合併局部膿瘍，經局部切開引流及清創後，證實為放線菌感染。經靜脈注射ampicillin-sulbactam 加上口服clindamycin 及amoxicillin/clavulanate potassiumc 共約四週後，門診追蹤無復發現象。

Actinomycetes are prominent among the normal f lora of oral cavity. As these microorganisms are not virulent, the companion bacteria appear to act as concurrent pathogens that enhance the invasiveness of actinomycetes. A break in the integrity of mucous membranes is the initial step of infection, and the hosts are usually immunocompromised. In a rare circumstance, the occurrence of bony invasion is possible and represents a much more severe infection. Here we reported a 44-year-old male who had a history of alcoholic liver cirrhosis and initially presented with a painless indurated mass in right submandibular region for more than 10 days. Prior to the submandibular swelling, the patient underwent the extraction of his right lower second molar. Physical examination revealed granuloma formation on and pus-like discharge from the right lower gingival. The overlying skin of adjacent jaw was discolorated and necrotic tissue was found. Computed tomography (CT) illustrated loss of alveolar bone with focal abscess formation in right mandible. Debridement was performed and the histopathology reported an actinomycotic infection. We treated the patient with intravenous ampicillin-sulbactam for 1 week and then shifted to oral amoxicillin/clavulanate potassiumc for 14 days, followed by clindamycin for another 14 days. The patient had three follow-ups and the wound recovered uneventfully.