Correct Answer: A. Actinomyces israelii

Explanation

Actinomyces israelii are filamentous gram positive bacteria that typically present as fluctuant nodules classically at the angle of the jaw (“lumpy jaw”) with fistulas and draining sinuses with “sulfur granules”. Treatment is with IV penicillin.

Reference:

Bonnefond S, et al. Clinical features of actinomycosis: A retrospective, multicenter study of 28 cases of miscellaneous presentations. Medicine (Baltimore). 2016;95:e3923.

Associated DIR Section: Infectious Diseases of the Skin

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