Scot Med J
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We report a 72-year-old patient who presented with an ulcerated palatal mass, weight loss and adrenal insufficiency. Repeated biopsies from the mass revealed actinomycosis with no features of malignancy, while computed tomography scanning revealed a left maxillary sinus mass with invasive features and bilateral large adrenal masses. Blood and urine investigations showed adrenal insufficiency. ⋯ We describe the clinical progress and review the related literature. Interestingly, 9 out of the 12 reported cases of concomitant actinomycosis and malignancy (including this case) involve haematological malignancy. A high index of suspicion and treatment response reassessment is important in the management of either rare clinical entity.
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Head and neck necrotising soft-tissue infection is exceptionally uncommon in the paediatric population. necrotising soft-tissue infection is severe and often life-threatening. Rapid spread of infection and systemic illness make necrotising soft-tissue infection a challenge for the medical and surgical teams. ⋯ Prompt surgical debridement with planned return visits to theatre and guided empirical antibiotic therapy ensured that a satisfactory patient outcome was achieved. The failure of current necrotising soft-tissue infection diagnostic scoring tools to be positive in this case may suggest that these tools require refinement and validation.