Tomlinson Michelle G, Chidarala Shreya, Lobo Brian C, Kalyatanda Gautam S
Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, USA.
Otolaryngology - Head and Neck Surgery, University of Florida, Gainesville, USA.
Cureus. 2023 Aug 23;15(8):e44002. doi: 10.7759/cureus.44002. eCollection 2023 Aug.
Non-tuberculous mycobacteria (NTM) are slow-growing opportunistic pathogens that cause a variety of cutaneous, soft tissue, and pulmonary infections. On rare occasions, NTM causes chronic rhinosinusitis, with the majority of cases presenting in immunocompromised individuals. Other potential risk factors include the presence of foreign bodies, previous sinus surgery or chemoradiation, and use of contaminated water in sinus rinses. We report here a rare case of NTM rhinosinusitis in an otherwise immunocompetent 66-year-old female. The patient underwent functional endoscopic sinus surgery where intraoperative acid-fast bacteria cultures grew She received five weeks of broad-spectrum IV antibiotic therapy followed by three months of oral azithromycin, tigecycline, and linezolid. A one-year post-operative visit showed appropriate healing without crusting or visible infection. This case contributes to the small handful of documented presentations of NTM rhinosinusitis in immunocompetent patients. NTM should be considered when patients present with refractory rhinosinusitis as they may require extended courses of antibiotic treatment. Familiarity with risk factors can further expedite making a diagnosis, ensuring prompt initiation of treatment and relief of symptoms for patients.
非结核分枝杆菌（NTM）是生长缓慢的机会致病菌，可引起多种皮肤、软组织和肺部感染。在极少数情况下，NTM可导致慢性鼻窦炎，大多数病例发生在免疫功能低下的个体中。其他潜在危险因素包括异物存在、既往鼻窦手术或放化疗，以及鼻窦冲洗中使用受污染的水。我们在此报告一例罕见的NTM鼻窦炎病例，患者为一名66岁免疫功能正常的女性。患者接受了功能性内镜鼻窦手术，术中抗酸菌培养生长……她接受了为期五周的广谱静脉抗生素治疗，随后口服阿奇霉素、替加环素和利奈唑胺三个月。术后一年随访显示愈合良好，无结痂或明显感染。该病例为免疫功能正常患者中少数有记录的NTM鼻窦炎表现之一。当患者出现难治性鼻窦炎时应考虑NTM，因为他们可能需要延长抗生素治疗疗程。熟悉危险因素可进一步加快诊断，确保为患者及时开始治疗并缓解症状。
