Post-COVID-19 Extensive Maxillary Actinomycotic Osteonecrosis: A Rare Case Report

Year 2025, Volume: 4 Issue: 1, 63 - 69, 30.04.2025

Mehmet Ali Altay , Cennet Neslihan Eroğlu , Büşra Karaca , Saffet Uğur Doğan

https://doi.org/10.62268/add.1652574

Abstract

Osteonecrosis can be seen in post-Covid-19 patients due to the damage to their immune systems and the medications they take. This case report deals with the diagnosis, treatment and follow-up of actinomycotic osteonecrosis of the maxilla, which is one of the very rare post-covid conditions. The medical history of the 48-year-old patient, who had received treatment for Covid-19 in the intensive care unit about 1 year ago and had no systemic disease, revealed left palatinal and buccal bone exposure, suppuration and oroantral relationship. After limiting the lesion with pentoxifylline and alpha tocopherol, all necrotic bone tissue was removed and the area was closed with Bichat fat pad. The removed tissue was sent for histopathologic and microbiologic examination. The area was closed primerally. Postoperative follow-up of 1 year was completed and no new lesion was observed. Microbiologic evaluation was positive for actinomyces. This case may shed light on clinicians to give importance to the follow-up of patients with Covid-19 and its variants, especially if they have a history of hospitalization, to provide a differential diagnosis for PC-RONJ even if the interval is long, and not to skip the microbiological evaluation stage.

Keywords

Post Covid-19, Actinomycosis, Osteonecrosis

Ethical Statement

The case report titled “Post-COVID-19 Maxillary Actinomycotic Osteonecrosis: Diagnosis, Treatment, and Follow-Up Outcomes” does not require Ethics Committee Approval for submission.

Supporting Institution

None

Project Number

-

References

• 1. Dar-Odeh N, Bobamuratova DT, Alnazzawi A, Babkair H, Jambi S, Abu-Hammad A, Abu-Hammad O.Jaw-related complications in COVID-19 patients; a systematic review. Cranio. 2024; 42: 630-7.
• 2. Al-Mahalawy H, El-Mahallawy Y, Dessoky NY, Ibrahim S, Amer H, Ayad HM, El Sherif HM, Shabaan AA. Post-COVID-19 related osteonecrosis of the jaw (PC-RONJ): an alarming morbidity in COVID-19 surviving patients. BMC Infect Dis. 2022; 22: 544.
• 3. Xu H, Zhong L, Deng J, Peng J, Dan H, Zeng X, Li T, Chen Q. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int J Oral Sci. 2020; 12: 8.
• 4. Gold JAW, Adjei S, Gundlapalli AV, Huang YA, Chiller T, Benedict K, Toda M. Increased Hospitalizations Involving Fungal Infections during COVID-19 Pandemic, United States, January 2020-December 2021. Emerg Infect Dis. 2023; 29: 1433-7.
• 5. Vasanthi V, Thulasiraman S, Krishnan R, Kumar AR. Actinomycotic osteonecrosis of the maxilla as a post-covid sequelae: a case report. Oral Oncol Rep. 2024; 9: 100220.
• 6. Moaddabi A, Cernera M, Armogida NG, Soltani P, Spagnuolo G. Actinomycotic Sinomaxillary Infection in a COVID-19 Patient: A Case Report and Review of the Literature. J Investig Med High Impact Case Rep. 2023; 11: 23247096231217823.
• 7. Arshad W, Mahmood Kamal M, Rafique Z, Rahat M, Mumtaz H. Case of maxillary actinomycotic osteomyelitis, a rare post COVID complication-case report. Ann Med Surg (Lond). 2022; 80: 104242.
• 8. Shetty L, Nahar S, Domah T, Raj AT. COVID-19 patients could be at high risk for dry socket. Med Hypotheses. 2021; 146: 110462.
• 9. Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS, Mehra MR, Schuepbach RA, Ruschitzka F, Moch H. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020; 395: 1417-8.
• 10. Daltro GC, Silva ICF, P. B. Daltro PB, Botelho VL. SARS-CoV-2/ COVID-1 and its Implications in the Development of Osteonecrosis. J Regen Biol Med. 2020; 2: 1-19.
• 11. Bennardo F, Buffone C, Giudice A. New therapeutic opportunities for COVID-19 patients with Tocilizumab: Possible correlation of interleukin-6 receptor inhibitors with osteonecrosis of the jaws. Oral Oncol. 2020; 106: 104659.
• 12. Song G, Liang G, Liu W. Fungal Co-infections Associated with Global COVID-19 Pandemic: A Clinical and Diagnostic Perspective from China. Mycopathologia. 2020; 185: 599-606.
• 13. Amorim Dos Santos J, Normando AGC, Carvalho da Silva RL, Acevedo AC, De Luca Canto G, Sugaya N, Santos-Silva AR, Guerra ENS. Oral Manifestations in Patients with COVID-19: A Living Systematic Review. J Dent Res. 2021; 100: 141-54.
• 14. Kudva A, Saha M, G S, S A, Sharma S. Nintedanib-induced osteomyelitis of the jaw against the background of COVID-19 infection. J Stomatol Oral Maxillofac Surg. 2024; 125: 101651.
• 15. Jawanda MK, Narula R, Gupta S, Sharma V, Sidhu SK, Kaur N. Mixed Infections (Mucormycosis, Actinomycosis and Candidiasis) Leading to Maxillary Osteomyelitis in a Diabetic Mellitus Patient in Post COVID Phase: First Case Report. Acta Medica (Hradec Kralove). 2021; 64: 218-23.
• 16. Zou X, Chen K, Zou J, Han P, Hao J, Han Z. Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection. Front Med. 2020;14: 185-92.