Pseudomonas aeruginosa causing inflammatory mass of the nasopharynx in an immunocompromised HIV infected patient: A mimic of malignancy

Abstract

Head and neck manifestations of acquired immunodeficiency syndrome are among the most common complications of this disease. The sinonasal and oral manifestations are more common that the otologic and range from malignancies to infectious processes caused by both opportunistic and nonopportunistic organisms. We report the case of a nasopharyngeal mass of infectious etiology in a severely immunocompromised HIV infected patient. The patient was admitted with a presumptive diagnosis of infectious gastroenteritis and was found to have a nasopharyngeal mass. The mass was extending into the oropharynx and paravertebral soft tissues and was associated with extensive secretions causing near complete occlusion of the oropharynx. CT scan findings favored malignant verses infectious etiology. The surgical biopsy performed twice ruled out malignancy and the bacterial culture proved to be a pure growth of Pseudomonas aeruginosa. Pseudomonas can inhabit the nasopharynx and lower digestive tract, and is only occasionally associated with causing disease in non-susceptible patients but is a common infection in immunocompromised patients. To the best of our knowledge, and after considering the current literature, we believe this case is unique. We discuss this rare entity and its management. Clinicians should be aware of this potential life threatening condition in the HIV population and add P. aeruginosa infection to the differential diagnosis of an acute inflammatory nasopharyngeal mass.

Keywords: HIV+; Malignancy; Nasopharynx mass; Pseudomonas aeruginosa.

Fig. 1

(A) CT scan in sagittal view of the neck with mass in the nasopharynx extending into the oropharynx and paravertebral soft tissues. (B) CT scan in transverse view of the neck: Many bilateral prominent enhancing cervical and superior mediastinal lymph nodes.

Fig. 2

Oral cavity after incision and drainage with biopsy.

Fig. 3

(A) Nasopharyngeal mucosa showing foci of severe acute inflammation in the subjacent soft tissue and minor salivary glands (H&E, ×25) and (B) Nasopharyngeal mucosa showing severe acute inflammation with focal necrosis in the subjacent soft tissue (H&E, ×40).

Fig. 4

(A) CT scan in sagittal view of the neck after incision and drainage. (B) CT scan in transverse view of the neck after incision and drainage. (C) CT scan in transverse view of the chest. Lesion appreciated left lobe.