Naguib M T, Byers J M, Slater L N
Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City.
Clin Infect Dis. 1994 Oct;19(4):789-91. doi: 10.1093/clinids/19.4.789.
Atypical mycobacteria, which are common opportunistic pathogens in patients with AIDS, have not been previously implicated in the pathogenesis of paranasal sinus infections; we describe two such patients. Clinical and radiographic evidence of bilateral maxillary and ethmoid sinusitis was observed for one patient; his infection proved resistant to therapy with conventional antimicrobials and decongestants. Endoscopic ethmoid sinus biopsy yielded a specimen containing acid-fast bacilli (AFB) that were later identified as Mycobacterium kansasii. Antimycobacterial therapy had not resulted in amelioration of the sinusitis > 2 months later, at which time he died of cerebral toxoplasmosis. The second patient presented with a tender right frontotemporal soft-tissue mass; a computed tomogram disclosed that it extended through the frontal bone to the frontal sinus. Inflamed tissue debrided from the sinus contained AFB; cultures first yielded M. kansasii and later Mycobacterium avium complex. Bacteremia due to both organisms was also demonstrated. Infection progressed despite therapy.
非典型分枝杆菌是艾滋病患者常见的机会性病原体，此前尚未被认为与鼻窦感染的发病机制有关；我们描述了两名此类患者。一名患者观察到双侧上颌窦和筛窦炎的临床和影像学证据；他的感染对传统抗菌药物和减充血剂治疗耐药。内镜下筛窦活检获得的标本中含有抗酸杆菌（AFB），后来鉴定为堪萨斯分枝杆菌。抗分枝杆菌治疗2个多月后鼻窦炎仍未改善，此时他死于脑弓形虫病。第二名患者表现为右侧额颞部软组织肿块压痛；计算机断层扫描显示肿块穿过额骨延伸至额窦。从鼻窦清除的炎症组织中含有AFB；培养最初分离出堪萨斯分枝杆菌，后来分离出鸟分枝杆菌复合群。还证实了两种病原体引起的菌血症。尽管进行了治疗，感染仍在进展。
