Clinical and histopathological features of cutaneous nontuberculous mycobacterial infection: a review of 13 cases.

Abstract

Background

The incidence of cutaneous nontuberculous mycobacterial (NTM) infection has increased in recent decades due to widespread use of immunosuppressive therapy and better detection methods. The histopathology of cutaneous NTM infection is not pathognomic and the organisms are slow and difficult to culture, making diagnosis challenging.

Methods

We reviewed the clinical and histopathological features of 13 cases of cutaneous NTM infection, and performed panmycobacterial polymerase chain reaction (PCR) on the paraffin blocks.

Results

The immunocompetent patients presented with localised lesions on the extremities, whereas the immunocompromised patients presented with disseminated cutaneous lesions. The histopathology in immunocompetent patients was characterised by pseudoepitheliomatous epidermal hyperplasia, intraepithelial abscesses, transepidermal elimination, and dermal granulomatous inflammation accompanied by necrosis and suppuration. The immunocompromised patients showed suppurative inflammation with little granuloma formation and numerous acid fast bacilli. Paraffin block PCR was positive in 4 of 13 cases (31%), whereas culture was positive in 11 of 13 cases (85%).

Conclusion

The aforementioned histological features should help in diagnosing cutaneous NTM infection when combined with clinical and microbiological correlation. In our study, we did not find paraffin block PCR to be superior to conventional culture in detecting cutaneous NTM infection.

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