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Background
This is a broad category of Mycobacterium, generally encomapassing all non-Tuberculosis and Leprosy strains. Prior to the AIDS epidemic, their importance was limited in scope. However, it is rapidly becoming a major cause of morbidity and mortality for immunocompromised patients.
OUTLINE
DISEASE ASSOCIATIONS CHARACTERIZATION PEDICURES
Rapidly growing mycobacterial infections after pedicures.Sniezek PJ, Graham BS, Busch HB, Lederman ER, Lim ML, Poggemyer K, Kao A, Mizrahi M, Washabaugh G, Yakrus M, Winthrop K.
Department of Flight Surgery, Naval Air Station Pensacola, Pensacola, Fla.
Arch Dermatol 2003 May;139(5):629-34 Abstract quote BACKGROUND: Rapidly growing mycobacteria (RGM) can cause a variety of cutaneous and systemic diseases. The causative organisms are typically Mycobacterium fortuitum or Mycobacterium chelonae (also known as Mycobacterium abscessus). Primary cutaneous lesions may develop after a variable latent period, from weeks to several months, and usually result from direct inoculation after trauma, from injections, or during surgery via contaminated medical instruments. Recently, investigators from the Centers for Disease Control and Prevention, Atlanta, Ga, and the California Department of Health Services, Berkeley, documented a large, unprecedented outbreak of community-acquired RGM infection, during which more than100 patrons of a northern California nail salon contracted furunculosis in their legs as a result of exposure to whirlpool footbaths that were contaminated with M fortuitum.
OBSERVATIONS: We report the clinical and epidemiological findings in 3 cases of lower extremity RGM infections that occurred after similar whirlpool footbath exposure at several different nail salons in southern California. These infections typically presented as recurrent furunculosis, causing considerable morbidity as a result of scarring, delayed diagnosis, and the need for long-term polymicrobial therapy.
CONCLUSIONS: Rapidly growing mycobacterial infections related to pedicures may continue to occur in a sporadic fashion. Clinicians should consider the possibility of RGM infection and inquire about recent pedicures in a patient with recurrent lower extremity furunculosis and abscesses that are unresponsive to conventional antibiotic therapy.
GROSS APPEARANCE/
CLINICAL VARIANTSCHARACTERIZATION BACTERIAL VARIANTS M. FORTUITUM Perianal fistulae caused by Mycobacterium fortuitum.
Mukhopadhya A, Samal SC, Mukundan U, Patra S, Moses BV, Chacko A.
Department of GI Sciences, Christian Medical College & Hospital, Vellore, Tamil Nadu, India.
J Clin Gastroenterol. 2003 Feb;36(2):147-8. Abstract quote Mycobacterium fortuitum is a rapidly growing Mycobacterium , which usually colonizes the soil, dust and water.
It commonly causes skin and soft tissue infections especially in patients who have preceding trauma.
We report a case of perianal fistulae caused by M. fortuitum.
Clinical and Pathologic Features of Mycobacterium fortuitum Infections An Emerging Pathogen in Patients With AIDS
Michael B Smith, MD, Vicki J. Schnadig, MD, Michael C. Boyars, MD, and Gail L. Woods, MD
Am J Clin Pathol 2001;116:225-232 Abstract quote
The clinical and pathologic features of Mycobacterium fortuitum infection in 11 patients with AIDS were characterized.
Nine patients had cervical lymphadenitis; 2 had disseminated infection. The infection occurred late in the course of AIDS, and the only laboratory abnormality seen in more than half of patients (7/11) was relative monocytosis. Absolute monocytosis also was seen in 4 of 11 patients.
In both cytologic and histologic preparations, the inflammatory pattern was suppurative with necrosis or a mixed suppurative-granulomatous reaction. M fortuitum, a thin, branching bacillus, stained inconsistently in direct smear and histologic preparations. Staining was variable with Gram, auramine, Brown-Hopps, Gram-Weigert, Kinyoun, Ziehl-Neelsen, modified Kinyoun, and Fite stains. Organisms, when present, were always seen in areas of suppurative inflammation. Incorrect presumptive diagnosis, based on misinterpretation of clinical signs and symptoms or on erroneous identification of M fortuitum bacilli as Nocardia species, led to a delay in proper therapy for 7 of 11 patients.
Definitive therapy after culture identification resulted in complete resolution of infection in all patients except 1.
Soft-tissue infections caused by Mycobacterium fortuitum complex following penetrating injury.Subbarao EK, Tarpay MM, Marks MI.
Am J Dis Child. 1987 Sep;141(9):1018-20 Abstract quote Soft-tissue infections caused by rapidly growing mycobacteria may follow penetrating trauma.
We present four immunologically normal patients in whom soft-tissue infections with Mycobacterium fortuitum developed after they stepped on nails. Their presentations were clinically indistinguishable from puncture wound infections caused by Pseudomonas aeruginosa and Staphylococcus aureus. The acid-fast organisms grew on standard bacteriologic media within three to five days. Speciation and antimicrobial susceptibility testing was performed.
The primary mode of therapy was surgical; adjunctive antimicrobial therapy is recommended only for extensive or chronic infections and in immunocompromised hosts. All four of our patients had good outcomes after therapy.
M. KANSASII Disseminated cutaneous infection with Mycobacterium kansasii: Genotyping versus phenotyping
Chin-Yuan Tzen, MD, PhD
Tien-Ling Chen, MD
Tsu-Yen Wu, BSc
Dine-Ie Yong, MS
Huei-Chung Lee, BSc
Taipei, TaiwanJ Am Acad Dermatol 2001;45:620-4 Abstract quote
Mycobacterium kansasii is a common and virulent pathogen. However, primary cutaneous M kansasii infection has rarely been reported, totaling to only 34 cases since 1965. This low incidence has not been explained, but probably is due to difficulty in culture or phenotyping.
We describe the first reported case of cutaneous M kansasii diagnosed by genotyping, which is based on the DNA extracted from the formalin-fixed and paraffin-embedded tissue.
CLINICAL VARIANTS OTITIS MEDIA Mycobacterium avium intracellulare otitis media
Jacqueline K. Trupiano, MD
Richard A. Prayson, MDAnn Diagn Pathol 2001;5:350-353 Abstract quote
Atypical mycobacterial infections of the middle ear are extremely rare. To our knowledge, only eight cases have been reported in the literature, five of which involve Mycobacterium avium intracellulare.
We present a case of culture-proven, M. avium intracellulare otomastoiditis in an 8-year-old boy with common variable immunodeficiency syndrome. The patient clinically presented with pain and otorrhea. The histopathology was marked by acid-fast bacilli-laden histiocytes.
Consideration of this entity in the differential diagnosis of chronic, recalcitrant otorrhea can lead to timely diagnosis, treatment, an decreased morbidity.
LIVER Mycobacterium mucogenicum Isolated From a Patient With Granulomatous Hepatitis
Mark R. Goldblatt, MS and Julie A. Ribes, MD, PhD
From The College of Osteopathic Medicine, The University of Health Sciences, Kansas City, Mo (Mr Goldblatt); the Department of Pathology and Laboratory Medicine, University of Kentucky Medical Center, Lexington, Ky (Mr Goldblatt and Dr Ribes); and Veterans Administration Medical Center, Lexington, Ky (Dr Ribes).
Arch Pathol Lab Med 2002;Vol. 126, No. 1, pp. 73–75. Abstract quote
Mycobacterium mucogenicum is a recently characterized, rapid-growing mycobacteria rarely seen in human infections.
We describe the case of a 51-year-old man with rapidly progressive granulomatous hepatitis caused by M mucogenicum. Although premortem evaluation failed to identify an etiologic agent, autopsy liver cultures produced smooth, rapid-growing mycobacterial colonies.
Biochemical, growth, and cell wall fatty acid characteristics were consistent with the identification of M mucogenicum.
LUNGS Diffuse Pulmonary Disease Caused by Nontuberculous Mycobacteria in Immunocompetent People (Hot Tub Lung)
Andras Khoor, etal.
Am J Clin Pathol 2001;115:755-762 Abstract quote
The clinicopathologic spectrum of infections due to nontuberculous mycobacteria (NTM) includes cavitary disease, opportunistic infection, and nodular disease associated with bronchiectasis.
We report a less well-described manifestation of NTM infection: 10 immunocompetent patients without preexisting bronchiectasis had radiographic evidence of diffuse infiltrative lung disease. The most common symptoms were dyspnea, cough, hypoxia, and fever. All 10 patients had used a hot tub.
Histologic examination revealed exuberant nonnecrotizing, frequently bronchiolocentric, granulomatous inflammation in all cases. In 1 case, necrotizing granulomas were also noted. The inflammation often was associated with patchy chronic interstitial pneumonia and organization. Cultures revealed NTM in all cases ( Mycobacterium avium complex in all but 1 case), but staining for acid-fast bacilli was positive in only 1 case. Four patients received corticosteroids alone for presumed hypersensitivity pneumonia, 4 were treated with antimycobacterial therapy, and 2 received both. All patients demonstrated significant improvement at the time of follow-up.
These findings suggest that disease due to NTM may manifest as diffuse infiltrates in immunocompetent adults and that hot tub use may be an important risk factor for this disease pattern.
SKIN
Department of Dermatology, Ha'emek Medical Center.
BACKGROUND: Absence of a pathognomonic clinical picture and variable histologic findings often delay diagnosis of nontuberculous mycobacteria (NTM)-induced cutaneous infections, and antimicrobial therapy varies.
OBJECTIVE: We sought to investigate the clinical, microbiologic, and pathological findings of cutaneous NTM infections and response to different treatments.
METHODS: Records of patients with NTM infections of the skin confirmed by positive cultures or histologic findings were reviewed. Clinical, microbiologic, and epidemiologic data were collected and skin biopsy specimens were reassessed.
RESULTS: The series included 25 cases, one diagnosed by histology and 24 by positive culture: 16 cases with Mycobacterium marinum, 3 of atypical Mycobacterium without species identification, and one each with M chelonae, M xenopi, M abscessus, M gordonae, and M fortuitum. One of 16 patients with M marinum developed tenosynovitis. Mean interval between clinical presentation and diagnosis was 7.1 months (range: 1-27.3 months). All isolates analyzed for antimicrobial susceptibility pattern were sensitive to clarithromycin.
LIMITATIONS: Limitations include methods of case collection, retrospective study, and relatively small number of patients.
CONCLUSIONS: Diagnosis of NTM should be confirmed by histology and bacteriology studies of tissue cultures. Strong clinical suggestion of M marinum infection warrants initial empirical treatment to prevent progression to deep infection. The recommended treatment as indicated by the results of the in vitro susceptibility and clinical response is clarithromycin.Clin Exp Dermatol 1998;23:214-221
Most common presentations include draining sinuses, abscesses, ulcers, and nodules with multicentric or sporotrichoid patterns
Tissue cultures revealed the following in 13 patients:
M. fortuitum complex 9/13
M. avium 3/13
M. marinum 1/13Arch Dermatol 2000;136:1347-1352
8 patients from private geographically separate surgical facilities
M. fortuitum 3/8
M. abscessus 5/8All patients J Am Acad Dermatol 2002 Nov;47(5 Suppl):S249-50 Related Articles, Links
Sporotrichoid cutaneous Mycobacterium avium complex infection.Kayal JD, McCall CO.
Department of Dermatology, Emory University.
Mycobacterium avium complex, a common opportunistic pathogen among patients with AIDS, usually manifests as disseminated disease involving the lung, lymph nodes, and gastrointestinal tract. Primary cutaneous infections with M avium complex are extremely rare, and most cutaneous lesions are caused by dissemination. Cutaneous manifestations thus far reported include scaling plaques, crusted ulcers, ecthyma-like lesions, verrucous ulcers, inflammatory nodules, panniculitis, pustular lesions, and draining sinuses. Localized skin involvement resembling sporotrichosis is unusual and to our knowledge has been reported only once in the English-language literature. We describe an additional case of primary cutaneous M avium complex infection manifesting as sporotrichosis-like lesions on a patient with AIDS.
exhibited signs of inflammation, microabscesses, and purulent wound drainage within 24 months of procedure
Incubation periods ranged from 7 days to 2 years
Sporotrichoid cutaneous Mycobacterium avium complex infection.Kayal JD, McCall CO.
Department of Dermatology, Emory University.
J Am Acad Dermatol 2002 Nov;47(5 Suppl):S249-50 Abstract quote Mycobacterium avium complex, a common opportunistic pathogen among patients with AIDS, usually manifests as disseminated disease involving the lung, lymph nodes, and gastrointestinal tract. Primary cutaneous infections with M avium complex are extremely rare, and most cutaneous lesions are caused by dissemination. Cutaneous manifestations thus far reported include scaling plaques, crusted ulcers, ecthyma-like lesions, verrucous ulcers, inflammatory nodules, panniculitis, pustular lesions, and draining sinuses. Localized skin involvement resembling sporotrichosis is unusual and to our knowledge has been reported only once in the English-language literature.
We describe an additional case of primary cutaneous M avium complex infection manifesting as sporotrichosis-like lesions on a patient with AIDS.
HISTOPATHOLOGICAL VARIANTS CHARACTERIZATION ABSCESS, DERMAL
Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Mycobacterial infections of the skin classically cause a granulomatous tissue reaction. We have observed a suppurative pattern of inflammation associated with infections by rapid-growing Mycobacterium species in immunocompromised patients.
We report 6 cases in skin and soft tissue with an unusual but consistent lack of a predominance of granulomatous inflammation. Of the 6 cases, 4 had predominantly (approximately 75%) suppurative inflammation, 1 case predominantly demonstrated (approximately 75%) a mix of acute and chronic inflammation, and 1 case showed an approximately equal contribution of suppurative and granulomatous inflammation. All 6 cases showed abscess formation and numerous acid-fast bacilli (AFB) on AFB stain and were confirmed by tissue culture. Of these 6 cases, 2 had microabscesses with central pseudocysts harboring microorganisms. Five patients were taking oral prednisone, and 1 had an uncharacterized immunodeficiency.
These cases highlight the need for awareness of this unusual manifestation of infection with rapid-growing Mycobacterium species, particularly in immunocompromised patients.LICHENOID DERMATITIS
S Breza T Jr, Magro CM.College of Medicine, The Ohio State University, Columbus, OH 43221, USA.
BACKGROUND: Lichenoid and granulomatous dermatitis defines a distinctive pattern of cutaneous inflammation that may be part of the morphologic spectrum of idiopathic lichenoid reactions such as lichen planus and as well may be seen with lichenoid drug reactions, endogenous T-cell dyscrasias and as a feature of certain systemic diseases especially Crohn's disease and rheumatoid arthritis.
RESULTS: We encountered three cases of lichenoid and granulomatous dermatitis in which the basis was one of primary cutaneous Mycobacterium infection. In all three cases acid fast stains revealed pathogenic organisms and as well cultures were positive for Mycobacterium kansasii in one case and Mycobacterium marinum in another. Other features included a prominent perineural and periadnexal lymphocytic infiltrate.
CONCLUSIONS: The differential diagnosis of lichenoid and granulomatous dermatitis should also encompass primary cutaneous Mycobacterium infection in addition to the other more characteristic entities associated wtih this distinctive reaction pattern. Infection with Mycobacterium induces a TH1 dominant response which would hence produce an infiltrate.M. KANSASII
Pathologic features of Mycobacterium kansasii infection in patients with acquired immunodeficiency syndrome.Smith MB, Molina CP, Schnadig VJ, Boyars MC, Aronson JF.
Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555-0740, USA.
Arch Pathol Lab Med 2003 May;127(5):554-60 Abstract quote CONTEXT: Mycobacterium kansasii is a slow-growing photochromogenic mycobacterium that may infect patients with human immunodeficiency virus (HIV) late in the course of acquired immunodeficiency syndrome (AIDS). The clinical features of pulmonary and extrapulmonary infections have been described in the literature; however, the pathology of infection has not been adequately addressed. OBJECTIVE: This report describes the pathologic features of 12 cases of M kansasii infection in patients with AIDS.
DESIGN: The medical records, autopsy protocols, cytologic material, and histologic material from patients with AIDS and concomitant M kansasii infection at a tertiary-care medical center during 1990-2001 were reviewed.
RESULTS: Twelve cases were identified, 6 by autopsy, 5 of which were diagnosed postmortem. Four of the 12 cases had cytologic material and 4 cases had histologic biopsies available for review. Pulmonary infection was most common (9/12), and all patients in whom thoracic lymph nodes were assessed showed involvement (7/7). Abdominal infection was less frequent, with only 1 of 6, 2 of 6, and 2 of 6, demonstrating liver, spleen, and abdominal lymph node infection, respectively. Isolated infections without documented pulmonary infection included brain abscess (n = 1), ulnar osteomyelitis (n = 1), and paratracheal mass (n = 1). Cytologic and histologic material showed a wide range of inflammatory reactions, including granulomas with and without necrosis, neutrophilic abscesses, spindle-cell proliferations, and foci of granular eosinophilic necrosis. The M kansasii bacillus was characteristically long, coarsely beaded, and frequently showed folded, bent, or curved ends. Intracellular bacilli were randomly or haphazardly distributed within histiocytes.
CONCLUSION: Mycobacterium kansasii infection produces predominantly pulmonary infection in late-stage AIDS with a high incidence of thoracic lymph node involvement and a much lower incidence of dissemination to other sites. Infection is manifest as a wide variety of inflammatory reactions on cytology and histology; however, the characteristic appearance of the bacillus on acid-fast bacilli stain and its intracellular arrangement in histiocytes can allow a presumptive identification.M. MARINUM
Mycobacterium marinum Infection Simulating Interstitial Granuloma Annulare: A Report of Two Cases.Barr KL, Lowe L, Su LD.
Am J Dermatopathol 2003 Apr;25(2):148-51 Abstract quote We report two cases of Mycobacterium marinum infection that histologically simulated interstitial granuloma annulare (GA).
In one case, an infectious etiology was not suspected in histologic sections, but a tissue culture performed during the patient's clinic visit identified M. marinum, and a subsequent Fite stain revealed mycobacteria. Interstitial granulomatous dermatitis is a rare presentation for cutaneous nontuberculous mycobacteria and has yet to be attributed specifically to M. marinum.
In both immunocompetent and immunosuppressed patients, infection with M. marinum should be considered in lesions histologically resembling interstitial GA, particularly when there is clinical suspicion for an infectious process.
MYCOBACTERIUM SPINDLE CELL PSEUDOTUMOR
Pseudotumor resulting from atypical mycobacterial infection: a "histoid" variety of Mycobacterium avium-intracellulare complex infection.Wood C, Nickoloff BJ, Todes-Taylor NR.
Am J Clin Pathol 1985 Apr;83(4):524-7 Abstract quote A 54-year-old immunosuppressed cardiac transplant recipient with a six-month history of progressive swelling of the hand, with nodules and linear lymph node chain enlargement, diagnosed as a sporotrichoid Mycobacterium avium-intracellulare pseudotumor is described. The microscopic features closely resembled the previously described histoid variety of lepromatous leprosy.
Routine hematoxylin and eosin staining suggested a spindle cell neoplasm rather than an infectious or inflammatory process. An infectious etiology was pursued on the basis of the clinical setting.
Mycobacterial spindle cell pseudotumor of lymph nodes.
Chen KT.
Department of Pathology, Saint Agnes Medical Center, Fresno, California 93720.
Am J Surg Pathol 1992 Mar;16(3):276-81 Abstract quote Two cases of spindle cell pseudotumor in the lymph nodes of patients with acquired immunodeficiency syndrome caused by mycobacterial infection are reported and the literature reviewed.
The lesions mimicked neoplasms because they were composed predominantly of spindle cells arranged in a storiform pattern. Most of the spindle cells were phagocytic cells that contained large amounts of mycobacteria.
It is important for the pathologist to recognize the lesion so that a prompt tissue diagnosis can be provided because specific therapy is available.
Fine needle aspiration cytology of mycobacterial spindle cell pseudotumor. A case report.Corkill M, Stephens J, Bitter M.
Department of Pathology, University of Colorado Health Sciences Center, Denver.
Acta Cytol 1995 Jan-Feb;39(1):125-8 Abstract quote We report a case of mycobacterial spindle cell pseudotumor (MSP) in a lymph node from an acquired immunodeficiency syndrome patient diagnosed by fine needle aspiration (FNA). The FNA cytology was characterized by spindle cell proliferation without the typical foamy histiocytes usually seen in mycobacterial infections and mimicked a mesenchymal neoplasm, particularly Kaposi's sarcoma.
This case illustrates the importance of including MSP in the differential diagnosis of lymph node FNAs from immunocompromised patients, particularly those that show spindle cell proliferation suspicious for Kaposi's sarcoma or another mesenchymal neoplasm.
Spindle cell tumors associated with mycobacteria in lymph nodes of HIV-positive patients: 'Kaposi sarcoma with mycobacteria' and 'mycobacterial pseudotumor'.Logani S, Lucas DR, Cheng JD, Ioachim HL, Adsay NV.
Department of Pathology, Harper Hospital, Karmanos Cancer Institute and Wayne State University, Detroit, Michigan 48201, USA.
Am J Surg Pathol 1999 Jun;23(6):656-61 Abstract quote Patients infected with HIV often have unusual manifestations of common infections and neoplasms. One such example is "mycobacterial pseudotumor," an exuberant spindle cell lesion induced in lymph nodes by mycobacteria. Kaposi sarcoma also produces a spindle cell proliferation in lymph nodes of HIV-positive patients. These two entities must be differentiated from one another because of differences in treatment and prognosis.
We report here, however, three cases of intranodal Kaposi sarcoma with simultaneous mycobacterial infection, the occurrence of which has not been clearly documented. For comparison, we also studied three cases of mycobacterial pseudotumor, of which 14 cases have been described to date. There was considerable histologic overlap between these two lesions. Acid-fast bacilli were present in all cases, predominantly in the more epithelioid histiocytes in the cases of Kaposi sarcoma, and in spindle and epithelioid cells in the cases of mycobacterial pseudotumor.
The morphologic features that favored Kaposi sarcoma over mycobacterial pseudotumor were the prominent fascicular arrangement of spindle cells and slitlike spaces, the lack of granular, acidophilic cytoplasm, and the presence of mitoses. Immunohistochemistry was a reliable adjunct study in the differential diagnosis, as the spindle cells in mycobacterial pseudotumor were positive for S-100 protein and CD68 whereas those of Kaposi sarcoma were CD31- and CD34-positive but negative for S-100 protein and CD68. Awareness that Kaposi sarcoma may coexist with mycobacterial infection in the same biopsy specimen is important because these lesions may be misdiagnosed as mycobacterial pseudotumor.
The clinical impact of distinguishing between Kaposi sarcoma with mycobacteria and mycobacterial pseudotumor is significant because the presence of Kaposi sarcoma alters treatment and prognosis.
Mycobacterial spindle cell pseudotumor of the brain: a case report and review of the literature.Morrison A, Gyure KA, Stone J, Wong K, McEvoy P, Koeller K, Mena H.
Armed Forces Institute of Pathology, Department of Neuropathology, Washington, DC 20306-6000, USA.
Am J Surg Pathol 1999 Oct;23(10):1294-9 Abstract quote Spindle cell pseudotumors found in the skin, lymph nodes, bone marrow, spleen, lungs, and retroperitoneum have been reported recently in immunosuppressed patients, including those with acquired immunodeficiency syndrome.
The authors report a similar lesion limited to the brain in a 38-year-old human immunodeficiency virus-negative man receiving steroid therapy for treatment of sarcoidosis. Histopathologically the lesions were composed of spindle and epithelioid histiocytes, small foci of necrosis, and numerous acid-fast bacilli. The acid-fast bacilli were determined by culture and polymerase chain reaction to be Mycobacterium avium intracellulare.
Because of the uncommon histologic appearance of this lesion and the potential for treatment if recognized, mycobacterial spindle cell pseudotumors should be included in the differential diagnosis of spindle cell lesions in the brain in immunosuppressed patients.
Mycobacterial spindle cell pseudotumor of the appendix vermiformis in a patient with aids.Basilio-de-Oliveira C, Eyer-Silva WA, Valle HA, Rodrigues AL, Pinheiro Pimentel AL, Morais-De-Sa CA.
Departments of Pathology and Clinical Immunology, Gaffre e Guinle University Hospital, Rio de Janeiro, RJ, Brazil.
Braz J Infect Dis 2001 Apr;5(2):98-100 Abstract quote Mycobacterial pseudotumor (MP) is a rare pathologic presentation of both Mycobacterium tuberculosis and non-tuberculous mycobacterial disease, hitherto reported to occur only in immunosuppressed patients with or without human immunodeficiency virus infection. This lesion shares close pathologic resemblance to certain mesenchymal neoplasms, particularly Kaposi's sarcoma (KS), from which it must be properly differentiated due to distinct prognosis and therapy.
We report a case of MP obliterating the lumen of the appendix vermiformis in a 34-year-old patient who died of complications of AIDS at our hospital in Rio de Janeiro. A total of 24 cases of MP (including our patient) have been described in the literature. MP has been found especially in lymph nodes, but extranodal lesions have been described in the skin, spleen, lung, bone marrow, brain and, in our patient, the appendix vermiformis.
We offer a review of the other 23 published case reports of MP in both HIV-infected and uninfected patients and discuss the pathologic features that differentiate MP from KS.
PROGNOSIS AND TREATMENT CHARACTERIZATION Treatment Skin lesions may be treated with a combination of surgical drainage, debridement, and prolonged antibiotic treatment including amikacin, clarithromycin, and ciprofloxaxin Macpherson and Pincus. Clinical Diagnosis and Management by Laboratory Methods. Twentyfirst Edition. WB Saunders. 2006.
Rosai J. Ackerman's Surgical Pathology. Ninth Edition. Mosby 2004.
Sternberg S. Diagnostic Surgical Pathology. Fourth Edition. Lipincott Williams and Wilkins 2004.
Robbins Pathologic Basis of Disease. Seventh Edition. WB Saunders 2005.
DeMay RM. The Art and Science of Cytopathology. Volume 1 and 2. ASCP Press. 1996.
Weedon D. Weedon's Skin Pathology Second Edition. Churchill Livingstone. 2002
Fitzpatrick's Dermatology in General Medicine. 6th Edition. McGraw-Hill. 2003.
Weiss SW and Goldblum JR. Enzinger and Weiss's Soft Tissue Tumors. Fifth Edition. Mosby Elesevier 2008
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