Atypical Mycobacteria Infection Mimicking Cutaneous Sarcoidosis by Dr Rishi Agrawal in Journal of Clinical Case Reports Medical Images and Health Sciences

 Atypical Mycobacteria Infection Mimicking Cutaneous Sarcoidosis by Dr Rishi Agrawal in Journal of Clinical Case Reports Medical Images and Health Sciences

A 51 year-old male presented with a 2-week history of a firm and tender suprapubic lump. The patient denied constitutional symptoms. His medical history was significant for sarcoidosis. He was referred to a penile surgeon, the main clinical concern being that of malignancy.

MRI scanning revealed a 2.9cm encapsulated subcutaneous soft tissue mass separate from the penis. The pelvis and penis were unremarkable.

Microscopy from an US-guided biopsy revealed relatively ill-defined granulomatous inflammation with abundant admixed acute and chronic inflammatory cell infiltrate (Figures 1A-C). No necrosis or malignancy was seen

Special stains revealed conspicuous acid-fast bacilli, with no fungal elements identified (Figure 1D). Subsequent polymerase chain reaction (PCR) testing confirmed the presence of Mycobacterium avium (M. avium). Further clinical history revealed that the patient was on long-term prednisolone and methotrexate for sarcoidosis.

Teaching Point

This case demonstrates a cutaneous atypical mycobacterial infection arising in a medically immunosuppressed patient. The histological differential included cutaneous sarcoidosis, given the patients history. However, there were sufficient features to suggest that cutaneous sarcoidosis was unlikely, and that an infectious aetiology was more likely. In particular,• The granulomas in sarcoidosis are typically welldefined and exhibit less intervening inflammation (‘naked granulomas’). The extensive inflammation led us to investigate an infectious cause and request special stains.

Tuberculosis generally shows few bacilli on Ziehl-Nielsen staining, but the abundant microorganisms observed here suggest an atypical mycobacterial infection and therefore prompted PCR testing. This confirmed infection with M.Avium, which is found in the environment and can cause opportunistic infections in immunocompromised patients.

Conflict of Interest Statement: There is no conflict of interest to declare from any author. Statement of funding sources: There are no funding sources to declare.

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