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Lookup NU author(s): Professor Philip Sloan
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© 2023 Lippincott Williams and Wilkins. All rights reserved. While amoebic infection is widely known as a cause of gastroenteritis, keratitis, and meningoencephalitis, amoebae are challenging to recognize at unexpected sites. Despite multiple case reports of sinonasal amoebiasis, amoebic infection is not regularly considered in the differential diagnosis of sinonasal necroinflammatory disease. Here, we aim to characterize the pathologic features of sinonasal amoebiasis to facilitate better recognition. We identified sinonasal amoebiasis in 4 men, median age of 67 years (range: 37 to 71 y). All were immunocompromised, including 2 with chronic lymphocytic leukemia, 1 with human immunodeficiency virus, and 1 with human immunodeficiency virus and kidney transplant. Patients presented with nasal mucosal necrosis or polypoid masses, with facial ulceration in 1 patient and distant dermal nodules in another. Biopsies displayed extensive necrotic debris and inflammation. Although amoebic cysts were abundant in 3 cases, they were mistaken for yeast at frozen section in 1 case; 1 case showed only rare trophozoites that were not recognized on initial biopsy. Periodic acid Schiff and Grocott Methenamine Silver stains highlighted the organisms, and polymerase chain reaction confirmed Acanthamoeba species in 3 cases tested. 2 patients responded well to antiprotozoal medications, but 2 died of disease. Overall, sinonasal amoebiasis presents as a necroinflammatory process in patients immunocompromised for various reasons. Amoebae can mimic other organisms or be incredibly scarce, requiring active consideration to recognize amoebiasis and differentiate it from overlapping conditions like invasive fungal sinusitis, granulomatosis with polyangiitis, and natural killer/T-cell lymphoma. Because sinonasal amoebiasis is highly treatable when diagnosed promptly, pathologists play a critical role in the recognition of this rare necroinflammatory disease.
Author(s): McLean AC, Bishop JA, Guarner J, Montone KT, Morris CP, Sloan P, Rooper LM
Publication type: Article
Publication status: Published
Journal: American Journal of Surgical Pathology
Year: 2023
Volume: 47
Issue: 1
Pages: 102-110
Print publication date: 01/01/2023
Acceptance date: 02/04/2018
ISSN (print): 0147-5185
ISSN (electronic): 1532-0979
Publisher: Wolters Kluwer Health
URL: https://doi.org/10.1097/PAS.0000000000001951
DOI: 10.1097/PAS.0000000000001951
PubMed id: 35968953
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