mycobacterium marinum infection after infliximab therapy

a case of mycobacterium marinum infection of the nasal cavity is described. a 57 years old man was being on infliximab for 2 years for severe psoriasis presented with five months history of epistaxis, nasal blockage and snoring. local examination revealed bilateral nasal mass. the diagnosis of mycobacterial infection was suspected based upon the histopathological finding of granuloma in the biopsy specimen, and later confirmed by mycobacterial culture. the patient was treated with 3 months therapy of ethambutol and rifampicin with good clinical response. the clinical presentation of the case is discussed with a review of the literature about current guidelines for prophylaxis and other preventive strategy for infection among patients receiving tnf antagonists.