First case of multiple cranial nerve failure from actinomycosis leads to neurotrophic keratopathy

An 84-year-old German woman developed neurotrophic keratopathy with corneal ulceration following multiple cranial nerve paralysis caused by polyneuritis cranialis. Imaging revealed actinomycosis of a wisdom tooth as the underlying trigger. Initial conservative treatment failed, but the patient responded well to penetrating keratoplasty combined with amniotic membrane transplantation.

This case represents the first documented instance of multiple cranial nerve failure due to actinomycosis resulting in significant ophthalmic complications, highlighting the need for awareness of rare infectious causes in neuro-ophthalmic disease.

Reference
Welzel AM, Kondova M, Pfeiffer N, et al. Polyneuritis cranialis following actinomycosis of a wisdom tooth: a case report. J Med Case Rep. 2025;19(1):595. doi: 10.1186/s13256-025-05654-9. PMID: 41261399; PMCID: PMC12632100.

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