# Bilateral Jaw Mycobacterium Abscessus Mimicking Actinomycosis: A Postoperative Complication of Wisdom Teeth Extraction

## TL;DR

A case of jaw infection caused by Mycobacterium abscessus was mistaken for actinomycosis after a dental procedure, highlighting the need for accurate diagnosis.

## Contribution

This case highlights the diagnostic challenges of Mycobacterium abscessus mimicking actinomycosis and emphasizes the importance of microbial cultures.

## Key findings

- Mycobacterium abscessus infection was misdiagnosed as Actinomycoses israelii following wisdom teeth extraction.
- Dual antibiotic therapy with azithromycin and omadacycline led to clinical and radiographic improvement.
- Genetic mutations in Mycobacterium abscessus affect macrolide susceptibility, requiring tailored treatment.

## Abstract

The incidence of nontuberculous mycobacteria infections has surged over recent decades. Mycobacterium abscessus is one example that can present unique diagnostic challenges due to its variable antibiotic resistance profile and its clinical similarities to Actinomycoses israelii in postodontogenic infections. The authors report a case of a 22-year-old healthy female presenting with bilateral mandibular nodules following wisdom teeth extraction. After a presumptive diagnosis of actinomycosis, cultures revealed a Mycobacterium abscessus infection susceptible to macrolides. Magnetic resonance imaging depicted bilateral sinus tracts without osteomyelitis. The patient opted for dual antibiotic therapy, consisting of azithromycin and omadacycline, without surgical intervention. Given her clinical and radiographic improvement after three months, the patient elected to continue dual antibiotic therapy for 12 months with appropriate clinical and radiographic monitoring. This case underscores the importance of early microbial cultures to guide diagnosis and treatment, particularly considering Mycobacterium abscessus’s similarities with other pathogens and its variable macrolide susceptibility due to genetic mutations. As highlighted in this case, clinicians must successfully differentiate between and appropriately treat various nontuberculous mycobacteria.