Periapical actinomycosis is a relatively rare form of cervicofacial actinomycosis, which\ntypically involves the periapical region with subsequent potential spread to the jaw bones. We hereby\npresent two cases of periapical actinomycosis. Both patients presented with jaw pain and â??holesâ? in\ntheir gum and lacked the characteristic clinical features commonly seen in cervicofacial actinomycosis\nsuch as jaw mass, draining ulcers, sinuses and fistulae. The first patient was an immunocompetent\nhost with chronic stable medical conditions but with a rather bad dentition requiring multiple recent\nteeth extractions. The second patient was edentulous, had refractory multiple myeloma, was on\nlow-dose chronic steroids and pomalidomide therapy and therefore relatively immunocompromised.\nBoth cases of actinomycosis were diagnosed by jaw bone histopathology, which showed characteristic\nsulfur granules and embedded Actinomyces-like organisms. The two patients had excellent clinical\nresponse to six months of penicillin therapy without any need for surgical intervention. The cases\nremind clinicians of including actinomycosis in the differential diagnosis of periapical lesions and\nillustrates the possibility of achieving cure with non-surgical treatment.
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