{"id":"7f9e702d-cce9-4d93-874b-93c2a809f1e6","slug":"wolf-in-sheeps-clothing-intracranial-actinomycosis-masquerading-as-en-plaque-meningioma","title":"Wolf in Sheep&#8217;s clothing: Intracranial actinomycosis masquerading as <i>en-plaque</i> meningioma","authors":["Harsh Deora","Manish Beniwal","Shilpa Rao","K. V. L. N. Rao","V. Vikas","Sampath Somanna"],"abstract":"Background: Actinomycosis israeli is a gram-positive non-acid-fast bacterium and is the most common causative agent of actinomycosis. It usually presents as a brain abscess via a secondary spread from the cervicofacial region or lungs. However, presentation as an en-plaque lesion with bone involvement out of proportion to brain parenchyma is rare and needs to be acknowledged. Case Description: We report a case of intracranial en-plaque lesion in a 47-year-old female with restriction of mouth opening and right third nerve palsy for 1 year. Imaging showed hyperostosis of the maxilla, temporal base, sphenoid, and zygoma with dural thickening suggestive of a meningioma. Surgical decompression yielded a granulomatous lesion along with empirical antitubercular therapy. However, patient succumbed to the infection and final histopathology revealed actinomycosis infection. Conclusion: Adequate knowledge along with clinical suspicion are the pillars to treating this unfortunate disease. Cheek swelling with bone involvement should be actively sought as risk factors. This case presents a unique opportunity to identify the fox among the sheep by elucidating the characteristic imaging findings and intraoperative view of this rare entity.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/7f9e702d-cce9-4d93-874b-93c2a809f1e6/featured/hero-1782420880641.png","publishDate":"2018-02-14T00:00:00.000Z","doi":"10.4103/sni.sni_445_17","categories":["Infection","Case Report"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/7f9e702d-cce9-4d93-874b-93c2a809f1e6/pdf"}