Surgical management of cicatricial post-scleromatous sub-glottic stenosis

Rhinoscleroma: eight Peruvian cases

Rhinoscleroma is a rare infection in developed countries; although, it is reported with some frequency in poorer regions such as Central Africa, Central and South America, Eastern and Central Europe, Middle East, India and Indonesia. Nowadays, rhinoscleroma may be erroneously diagnosed as mucocutaneos leishmaniasis, leprosy, paracoccidioidomycosis, rhinosporidiasis, late syphilis, neoplasic diseases or other upper airway diseases. From 1996 to 2003, we diagnosed rhinoscleroma in eight patients attended in the Dermatologic and Transmitted Diseases service of "Cayetano Heredia" National Hospital, in Lima, Peru. The patients presented airway structural alterations producing nasopharyngeal, oropharyngeal and, in one patient, laryngeal stenosis. Biopsy samples revealed large vacuolated macrophages (Mikulicz cells) in all patients. Ciprofloxacin 500 mg bid for four to 12 weeks was used in seven patients and oxytetracycline 500 mg qid for six weeks in one patient. After follow-up for six to 12 months the patients did not show active infection or relapse, however, all of them presented some degree of upper airway stenosis. These cases are reported because of the difficulty diagnosing the disease and the success of antibiotic treatment.

Scleroma of the larynx and associated squamous cell carcinoma: a causal relationship?

The known risk factors for development of laryngeal carcinoma are smoking, alcohol drinking, air pollution, laryngeal keratosis, single adult papillomas, and previous irradiation. Laryngeal scleroma as a risk factor for the development of laryngeal carcinoma has not been mentioned in the English-language literature, to my knowledge. This is a report of 2 cases of proven long-term rhinolaryngoscleroma that have changed to laryngeal carcinoma.

Laryngotracheal manifestations of rhinoscleroma

Rhinoscleroma is a rare, chronic granulomatous disease of infective causation. It usually begins in the nose and may progress to involve the larynx and trachea and cause dysphonia, stridor, and airway obstruction. Early rhinoscleroma is usually successfully treated with oral tetracycline, yet laryngotracheal disease may require operative intervention. The disease is rare in the United States, but with an increase in immigration from endemic areas, otolaryngologists should be familiar with the management of this rare disease. Current literature contains only a few reports describing the manifestations of this disease, mostly in the form of case studies. This study is a retrospective review of our institutional experience with the management of 22 patients with rhinoscleroma, 13 of whom had laryngotracheal involvement. The focus of this report is on the clinical manifestations of laryngotracheal scleroma. All of the patients were treated with long-term antibiotics. Nine patients underwent endoscopy with or without dilation and laser excision. Three patients required emergency tracheostomy, all of whom were ultimately decannulated without any sequelae. A rational approach to management of this unusual disease is provided.

Scleroma of the lower respiratory tract: case report and review of literature

The case of a 46-year-old man who presented with acute respiratory distress due to a tracheal mass is reported. The patient underwent endoscopic resection of the mass and the histopathology revealed scleroma. No other sites of involvement by scleroma were found. This case is reported because laryngotracheal involvement by scleroma as the only manifestation of this disease is extremely rare.

Rhinoscleroma and rhinosporidiosis

For North American otolaryngologists, rhinoscleroma and rhinosporidiosis are moving more into the differential diagnosis of chronic inflammatory diseases of the upper airway, particularly the nasal cavity. This change is occasioned by the influx of immigrants from parts of the world to which the diseases are endemic. Diagnosis is established by identification of the causal organisms, the readily seen Rhinosporidium seeberi for rhinosporidiosis and the more elusive Klebsiella rhinoscleromatis for rhinoscleroma.

Radiological diagnosis of rhinoscleroma--the 'palatal sign'

This paper reports a characteristic radiological finding observed in seven cases of rhinoscleroma with nasal involvement. The soft palate exhibits a marked thickening at its attachment to the hard palate which tapers off towards its free edge. This new sign could be of help in the early diagnosis of this condition.

Scleroma of the upper respiratory passages: a CT study

Scleroma is a chronic specific granulomatous disease endemic in Egypt. The nasal cavities were all affected in the 37 patients examined. The paranasal sinuses and nasopharynx were involved in 17 patients, while the larynx and upper trachea were affected in five patients, four of whom were females. Twenty-three patients were in the granulomatous stage; the rest of the patients were in the atrophic and fibrotic stages. The main nasal and nasopharyngeal CT findings were soft tissue masses of variable sizes. The lesions were characteristically homogenous, non-enhancing and had distinct edge definition; adjacent fascial planes were not invaded. The subglottic area was involved in laryngeal and tracheal scleroma. The lesions were mainly in the form of concentric irregular narrowing of the airway. In the trachea, crypt-like irregularities were diagnostic of scleroma. Intra-orbital, intra-cranial and infratemporal parapharyngeal scleromatous masses were detected in one patient.