Actinomycosis:

Actinomycosis is a chronic, suppurating, granulomatous condition caused by bacteria producing branching hyphae, such as Actinomyces israelii. Most commonly affecting the cheek or mandibular skin, lesions can also be located in the thorax or elsewhere. Actinomyces, produces a chronic fibrotic necrotizing process that crosses tissue planes and may involve the pleural space, ribs, vertebrae, and subcutaneous tissue, with eventual discharge of sulfur granules (macroscopic bacterial masses) through the skin (empyema necessitatis).
Typically, there is a group of dull red nodules, with sinuses draining colonies of organisms called "sulfur" granules.
In the mouth and elsewhere, the lesion extends from a focus of bone involvement, or from some deeper focus.
Treatment:
- Long term (more than a year), high dose (10 million units daily) penicillin may be required, with or without surgical debridement.
- Alternatives include imipenem and erythromycin.