Myocbacterium-Avium Intracellulare Associated Inflammatory Pseudotumor of the Anterior Nasal Cavity

Abstract

In this case report, we describe an unusual case of mycobacterial associated inflammatory pseudotumor that occurred in a patient with a previous history of cocaine abuse. We discuss inflammatory pseudotumor (IPT) in general and emphasize the rare entity where an associated mycobacterial infection is seen. The histogenesis is not yet completely understood. The lesion can pose challenges for practicing pathologists and a misdiagnosis of malignancy can occur at multiple facets. A discussion about the differential diagnosis and clues to make the distinction is presented. In addition to spindle cell proliferation, the presence of a background of mixed inflammatory cell infiltrate and foamy macrophages are clues to make the diagnosis. In the case of mycobacteria associated IPT, Acid Fast Bacilli (AFB) stains will easily highlight the organisms confirming the diagnosis.

Mycobacterium avium Infection of Nasal Septum in a Diabetic Adult: A Case Report

“…Middleton et al [16] showed exposing extracellular matrix by epithelial damage and poor mucus clearance will predispose to MAC airway infection. Previously reported cases of nasal and sinobronchial infections of MAC included history of cocaine use and long term aerosol inhalation cine-scintigraphy usage, which suggested that an impairment of the local defense mechanisms may play role in the pathogenesis of MAC infection [3,17]. Solyar et al reported thirty-seven Atypical mycobacterium (AM) associated chronic refractory rhinosinusitis (CRS) cases, which accounts for 5.3 % of outpatients and 2.6 % of OR patients with CRS.…”

“…Acid fast stain and PAS stain highlighted numerous short, uniformly staining coccobacilli within the foamy histiocytes (Figs. 3,4). The sheet of foamy histiocytes are strongly positive for CD68 (Fig.…”

“…There are very few reported MAC associated inflammatory pseudotumors of anterior nasal cavity cases. These reported inflammatory pseudotumors are caused by Mycobacterium avium-intracellulare and occurred in patients with immunosuppressed disease including HIV or post chemotherapy in a DLBC lymphoma [3]. To our knowledge, there is no previous reported Mycobacterium avium associated inflammatory polyp of nasal septum in patient with T2DM.…”

“…In non-HIV patients, MAC pulmonary infections are well documented, but there are not many case reports in the literature to describe isolated MAC infections with primary sites other than lung. These reported cases of extra-pulmonary MAC infections include pleuritis [2], nasal cavities [3], lymph nodes, skin and soft tissue [4][5][6][7]. There are very few reported MAC associated inflammatory pseudotumors of anterior nasal cavity cases.…”

Mucocutaneous Inflammatory Pseudotumours in Simultaneous Mycobacterium avium subsp. avium and Mycobacterium avium subsp. hominissuis Infection in a Cat

“…As a cause of focal or multifocal cutaneous and/or subcutaneous infection, MAC members can initiate three morphological forms of inflammatory response in infected cats: granulomatous, pyogranulomatous or spindle cell granulomas (Lee Gross et al, 2010). In human medicine, proliferation of spindle-shaped histiocytes containing acid-fast mycobacteria occurs as an inflammatory response to both tuberculous and nontuberculous mycobacteria (Ilyas et al, 2011). These benign lesions are referred to as mycobacterialinduced inflammatory 'pseudotumour' (IPT) and are described rarely.…”