We discussed an elderly homeless male with uncontrolled DM with recent dental surgery presenting with subacute painless swelling of his right mandible with acute development of purulent drainage diagnosed with cervicofacial actinomycosis.

1. Fistulization from the perimandibular region is the most easily recognized manifestation of cervicofacial actinomycosis

2. Presents as a chronic, slow progressive, NONTENDER, indurated mass that can involve into draining sinus tract or fistula and sometimes progress into an abscess

3. It can mimic NOCARDIA because it is Gram + filamentous rod however it is NOT acid fast

4. Treatment for severe infection with CTX IV or Penicillin G IV OR for mild infection with PO amoxicillin or PO penicillin V

5. Duration of treatment is 2-6 mo for MILD disease or 6-12 mo for SEVERE disease