Abstract Nontuberculous mycobacteria (NTM) are well established pathogens in patients with bronchiectasis and demonstrate increasing incidence as an important cause of chronic pulmonary disease. National and international NTM and bronchiectasis registries have demonstrated at least one third of patients have coexisting chronic rhinosinusitis (CRS). Small retrospective studies have demonstrated patients with symptoms of CRS to have cultures positive for NTM on endoscopic evaluation. Interestingly, NTM are not commonly considered a pathogen of the nasosinus passages and therefore it is at the discretion of the otolaryngologist to send AFB cultures when evaluating these patients. Given the high proportion of patients with NTM-PD and coexisting symptoms of CRS it raises the question of whether the nasal cavity may be similarly affected by NTM. We present a case series of three subjects, all female, aged 60 to 91 years, with coexisting NTM-PD and CRS who underwent nasal endoscopic evaluation and had cultures sent for bacterial, fungal cultures as well as AFB cultures to evaluate for sinonasal colonization. All patients demonstrated radiographic features of bronchiectasis with nodular, consolidative, or tree-in-bud opacities consistent with NTM infection, and sinus imaging findings consistent with CRS, including mucosal thickening or opacification. One patient had a history of sphenoidectomy for fungal sinusitis, another had similarly undergone sinus surgery for chronic infection. All three patients had sputum AFB cultures positive for Mycobacterium avium complex (MAC). All three patients had negative sinonasal AFB cultures despite persistent pulmonary infection. It remains plausible that there is a shared microbiologic profile between the upper and lower respiratory tracts that may include sinus NTM colonization, or even infection, in individuals already known to have NTM-PD and single sinus culture sampling may not be sensitive enough to establish this relationship.We present the above cases to highlight the potential relationship between upper and lower airway NTM pathogens and a need for more routine sampling of the nasal cavity in patients with NTM-PD and concomitant CRS. Among the studied risk factors for NTM-CRS immunosuppression, chemoradiation, presence of foreign body, and prior surgical intervention and non-sterile saline nasal rinsing have been reported, as well as the presence of comorbidities such as cystic fibrosis, granulomatosis with polyangiitis, and common variable deficiency.There is no available evidence to this date reporting incidence and prevalence of NTM-CRS disease in patients with NTM-PD. It remains imperative to obtain sinus ABF cultures in patients with coexisting CRS and NTM-PD to further study this potential association. This abstract is funded by: None
Lapinel et al. (Fri,) studied this question.