PARANASAL SINUS INFECTION DUE TO ATYPICAL MYCOBACTERIA IN 2 PATIENTS WITH AIDS

Atypical mycobacteria, which are common opportunistic pathogens in pat ients with AIDS, have not been previously implicated in the pathogenes is of paranasal sinus infections; we describe two such patients. Clini cal and radiographic evidence of bilateral maxillary and ethmoid sinus itis was observed for one patient; his infection proved resistant to t herapy with conventional antimicrobials and decongestants. Endoscopic ethmoid sinus biopsy yielded a specimen containing acid-fast bacilli ( AFB) that were later identified as Mycobacterium kansasii. Antimycobac terial therapy had not resulted in amelioration of the sinusitis >2 mo nths later, at which time he died of cerebral toxoplasmosis. The secon d patient presented with a tender right frontotemporal soft-tissue mas s; a computed tomogram disclosed that it extended through the frontal bone to the frontal sinus. Inflamed tissue debrided from the sinus con tained AFB; cultures first yielded M. kansasii and later Mycobacterium avium complex. Bacteremia due to both organisms was also demonstrated . Infection progressed despite therapy.