Question

A recent immigrant from rural Brazil presents with a swollen face and extremely poor dental hygiene, including loss of an adult tooth, which appears to be the focus of the current infection. There are two open ulcers on the outside of t he swollen cheek. Small yellow "grains" are seen in one of the ulcers. Gram stain shows purple-staining fine filaments. What is the most likely disease?

A. Actinomycotic mycetoma
B. Chromomycosis
C. Eumycotic mycetoma
D. Sporotrichosis
E. Paracoccidioidomycosis

Answer 1

The most likely disease based on the symptoms and Gram stain is Actinomycotic mycetoma, a chronic infection caused by Actinomyces species that produce characteristic sulfur granules and sinus tracts in the tissue.

Step-by-step explanation:

Most Likely Disease Diagnosis:

The most likely disease in this case, given the symptoms of a swollen face with poor dental hygiene, loss of an adult tooth, open ulcers on the cheek, and small yellow grains in the ulcers, plus the presence of purple-staining fine filaments on a Gram stain, is A. Actinomycotic mycetoma.

This condition is a chronic granulomatous infection caused by Actinomyces species which are characterized by the formation of sinus tracts, or small channels in the tissue that can discharge grains. These are small aggregates of bacteria, which appear yellow due to the presence of sulfur granules. Conditions such as trench mouth, chromomycosis, eumycotic mycetoma, sporotrichosis, and paracoccidioidomycosis have different causal pathogens and/or may not present with the same distinctive combination of features such as the sulfur granules and purple-staining fine filaments.