Doctors at Burgas University Hospital's ear, nose and throat clinic have diagnosed a rare infection that mimics cancer in an 89-year-old patient, the hospital said. They found cervicofacial actinomycosis after her family had taken her to see several specialists over five months without getting an answer.
The woman came in with a hard, painless swelling on her face and neck. The symptoms had started a few months after she got a dental prosthesis that was rubbing against the surrounding tissue. Before the diagnosis, she'd been through several courses of antibiotics, but none worked for long.
Scans showed damage to the soft tissue and bone of her lower jaw — a pattern that can also point to cancer. A biopsy found only chronic inflammation, with no clear answer. Doctors didn't find the bacterial colonies typical of the disease, because they're very small and show up only in isolated spots in the tissue. A larger surgical biopsy was ruled out because of the patient's advanced age and the high risk of surgery.
Doctors reached the diagnosis by piecing together several clues: the injury from the dental prosthesis, how long the symptoms had lasted, the fact that short courses of antibiotics hadn't worked, and specific features seen on the scans. The woman was treated with targeted antibiotics — two weeks intravenously, then three weeks by mouth. After the first ten days, the swelling had gone down by more than 70%, and over six months of follow-up the disease hasn't come back.
Actinomycosis is a rare, long-term bacterial infection. It's caused by bacteria that normally live in the mouth and move into deeper tissue when the lining is damaged. One of the tricky things about the disease is that it can look like a tumour, which makes it hard to diagnose.
Burgas University Hospital says the case shows what the clinic can do with complex, unusual diagnoses, when individual tests don't give a clear answer and a doctor's judgement and experience make the difference. The hospital added that the clinic also does research and regularly presents complex cases to fellow doctors.
The case was presented under the title "Cervicofacial actinomycosis – diagnostic and therapeutic aspects" at the 23rd IFOS World Congress of Otorhinolaryngology – Head and Neck Surgery 2026, held in Istanbul in September.