Keywords :
Rhinoscleroma Klebsiella Rhinoscleromatis, Nasal Inflammatory Disease, Chronic Granulomatous Infection, Medical and Surgical treatment
Citation Information :
Ali I, Natu SS, Singh S, Parveen G, Dubey M. Rhinoscleroma: A Case Report with Review of Literature. Arch Craniofac Sci 2015; 3 (1):1-7.
Aim: Rhinoscleroma is a rare disease hence the diagnosis can be difficult and delayed because of its clinical polymorphism. This article aims to review the entity and depict one of the treatment modalities for the same.
Background: Rhinoscleroma is a chronic granulomatous, slowly progressive disease affecting the nose and other respiratory tract structures, endemic in some areas of southern and central Europe, Africa and the USA. The first evidence of patients with scleroma was in a Mayan Indian terracotta head dated between 300 and 600 AD depicting the typical nasal proliferative lesions of this disease. Hebra and Kohn in 1870 first described the condition as “rhinoscleroma” and considered it a neoplastic growth. Its inflammatory nature was first suggested by Gerber. We report herein one case of this disease in a patient living in Lucknow and include a review of the literature.
Case Description: The clinical and pathological features of patients diagnosed with rhinoscleroma are presented. A 45 years old female patient with a chief complaint of dull localized pain which aggravated during meals and subsided after medication. The swelling had gradually increased in size on right side of the face. She also had a complaint of watery nasal discharge associated with common cold along with nasal obstruction and difficulty in breathing during lying down position. Post histopathological confirmation of our diagnosis, we performed debulking of the lesion intraorally and Ciprofloxacin 750 mg twice daily for 6 weeks along with the Augmentin 625mg thrice daily for 4 weeks and Metrogyl 400 mg thrice daily were given for 1 week, all from the day of debulking.
Conclusion: A combination of debulking and antibiotic therapy apparently produced satisfactory results for our patient. A study comparing this method of treatment with other treatment methods, such as the use of pharmacotherapy alone in such patients, with a longer follow up would be of considerable interest. Clinical Significance: A combination of debulking and antibiotic therapy can be taken into consideration as surgery results in immediate symptomatic relief and decrease the microbial load thereby increasing the sensitivity of the pharmacological therapy.
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Gamea, A.M. & El-Tatawi, F.A. - The effect of rifampicin on rhinoscleroma: an electron microscopic study. J. Laryngol. Otol 1990; 104: 772-777.
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Gaafar, H.A. & El Assi, M.H. - Skin affection in rhinoscleroma. A clinical, histological and electron microscopic study on four patients. Acta Otolaryngol 1988;105: 494-499.
Bahri, H.C.; Bassi, N.K. & Rohatgi, M.S. - Scleroma with intracranial extension. Ann. Otol. Rhinol. Laryngol 1972; 81: 856-859.
Evrard I, Gruyer X, Desse P, Francois A, Marie JP, Dehesdin D, et al. Spheno-ethmoidal rhinoscleroma. Report of a case and review of the literature. Ann Otolaryngol Chir Cervicofac 1998;115:85-8.
Chan TV, Spiegel JH. Klebsiella rhinoscleromatis of the membranous nasal septum. J Laryngol Otol 2007;121:998- 1002.
Podschun, R. & Ullmann, U. - Klebsiella spp. As nosocomial pathogens: epidemiology, taxonomy, typing methods, and pathogenicity factors. Clin. Microbiol. Rev 1998;11: 589- 603.
Kim, N.R.; Han, J. & Kwon, T.Y. - Nasal rhinoscleroma in a nonendemic area: a case report. J. Korean med. Sci 2003; 18: 455-458.
Ulcerative/necrotizing diseases of the nose and paranasal sinusescurrent Diagnostic Pathology 1995; 2:236-255
Canalis RF, Zamboni L. An interpretation of the structural changes responsible for the chronicity of rhinoscleroma. Laryngoscope 2001;111:1020-6.
Gaafar, H.A.; Bassiouny, M.; El-Mofty, M.; Badour, N.M. & Nour, Y.A. - Experimental intravenous inoculation of Klebsiella rhinoscleromatis bacilli in albino rats: a histopathological and bacteriological study. Acta Otolaryngol 2000;120: 279- 285.
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