Rhinoscleroma: eight Peruvian cases

Rhinoscleroma in a 9-year old boy: Rare case report

Rhinoscleroma is a rare benign granulomatous disease in children, the pathogen of which is Klebsiella rhinoscleromatis. Rhinoscleroma almost always affects the respiratory tract, the nasal cavities are the most common site, but can also be found over the entire extent of the respiratory tree, clinically the patient often presents with nasal obstruction with other non-specific signs, Histology is the basis of the diagnosis of rhinoscleroma. Early and appropriate medical treatment improves the prognosis and prevents progression to disabling sequelae. We present the case of a 9-year-old child who presented to the pediatric emergency department with a 2-month history of nasal obstruction unresponsive to medical treatment (Oxymetazoline). This was accompanied by mild nasal swelling and intermittent episodes of epistaxis. A CT scan of the paranasal sinuses was performed, ruling out a malignant tumor in the nasal cavity due to the absence of bone lysis. A nasal cavity biopsy with histopathological examination was conducted, confirming the diagnosis of rhinoscleroma. This was supported by the presence of an infiltrate rich in histiocytes and plasma cells, along with the identification of Russell bodies during PAS (Periodic Acid Schiff) staining. The patient underwent a medical treatment regimen involving a sulfamide-based antibiotic therapy (trimethoprim/sulfamethoxazole) for 8 weeks, along with a short-term corticosteroid therapy at a dose of 1 mg/kg/24 hours. At the first follow-up after 1 month, there was a noticeable reduction in nasal swelling and an improvement in nasal obstruction. A second follow-up 3 months later showed favorable results, with complete disappearance of both the swelling and nasal obstruction. Considering the possibility of recurrence, an annual follow-up was decided upon.

Cytodiagnosis of rhinoscleroma and its morphological clues: Our experience with four cases

Rhinoscleroma, a chronic progressive inflammatory disease of the upper respiratory tract, has a prolonged course and passes through three overlapping clinicopathologic stages. The histopathology findings are well illustrated in the literature; however, there is a paucity of reports explaining cytomorphological features of rhinoscleroma. It is the proliferative stage when disease presents as a nodular mass which can be targeted for cytological study. Here, the authors report fine-needle aspiration (FNA) cytology of four cases of rhinoscleroma who presented with intranasal firm, nodular lesions; its cytology revealed numerous, large, singly scattered histiocytes in a dense inflammatory background of lymphocytes, plasma cells, and few eosinophils. The microorganisms were visualized as intracytoplasmic loosely clustered, short rods within the histiocytes (Mikulicz cells) in May-Grunwald-Giemsa (MGG) smears. FNA sampling of rhinoscleroma in its nodular stage can yield classic cytomorphology with demonstration of organisms on air-dried smears which can further substantiate the cytodiagnosis. Thus, high index of suspicion and diligent search can aid in early and accurate diagnosed even on cytology with the help of conventional wet fixed Pap and air-dried MGG stain; both being complementary to each other and further can be supported with special stains such as periodic acid–Schiff stain or Gram whenever required.

Rebellious headache revealing an extensive rhinoscleroma: A case report and review of the literature

and importance: this case report aimed at an unusual case of extensive rhinoscleroma with a literature review, We report this case to bring attention to the patients with immunodeficiency problem regardless of presenting symptoms. Case presentation: a 70 -year-old patient with diabetes and hypertension, consulted for chronic median and posterior headaches have not improved with symptomatic treatment. She reported cacosmia without rhinorrhea and right otalgia. The examination of the nasal cavity showed a bleeding lesion on the lateral wall of the nasopharynx. CT-scan of the facial showed tissue lesion on the posterior and lateral walls of the nasopharynx, with infiltration of the parapharyngeal space and bone lysis right edge of the clivus. The biopsy confirmed the diagnosis of rhinoscleroma. The patient started the ciprofloxacin for 3 months, and the evolvement has noticed with the disappearance of the lesion during the first month of treatment. The patient started the ciprofloxacin for 3 months, and the evolvement was noticed with the disappearance of the lesion during the first month of treatment. Cilinical discussion: rhinoscleroma is a chronic and progressive granulomatous disease of the nasal cavities. The diagnosis is confirmed by the search for bacteria and an anatomopathological assessment of MIKULICZ cells. The medical treatment of choice has a high concentration in macrophages such as rifampicin and fluoroquinolone. Conclusion: rhinoscleroma is a granulomatous disease caused by klebsiella rhinoscleromatis, you must think about in front a nasopharyngeal lesion imitating a malignant pathology.

•

A rebellious headache may be indicate an extensive rhinoscleroma.

•

We report this case to bring attention to the patients with immunodeficiency problem regardless of presenting symptoms.

•

The possibility of an aggressive benign lesion like rhinoscleroma.

[Rhinoscleroma of the cavum with expression in cervical lymph nodes: about a case]

Le rhinosclérome est une affection granulomateuse spécifique et chronique d'évolution insidieuse, dont l'agent pathogène est le Klebsiella rhinoscleromatis. Il touche avec prédilection les fosses nasales, et pose parfois un problème de diagnostic positif. Nous rapportons le cas d'une patiente de 19 ans, qui présente un rhinosclérome atypique par sa localisation nasopharyngée rare, et son association exceptionnelle à une adénopathie cervicale sous angulo-mandibulaire droite. La mise en évidence des cellules de MIKULICZ à l'examen anatomo-pathologique a permis de poser le diagnostic. La patiente a été mise sous traitement antibiotique à base de ciprofloxacine pendant 16 semaines, associée à un nettoyage des fosses nasales par sérum physiologique. L'évolution était favorable avec un recul de 14 mois.

Long-term follow-up of repair of external nasal deformities in rhinoscleroma patients

INTRODUCTION

Rhinoscleroma (RS) is a chronic, progressive, granulomatous infectious disease endemic in Egypt and the Middle East, affecting the nose in 95-100% of cases, and resulting in functional and esthetic sequelae. The aim of the study was to investigate the feasibility of performing reconstructive procedures to improve external deformities in RS patients, with long-term follow up.

PATIENTS & METHODS

This prospective, controlled cohort study included 25 patients who were seeking rhinoplasty to improve their esthetic appearance, with evident clinical and histopathological history of RS. Another 25 patients seeking esthetic augmentation rhinoplasty in the same period formed the control group. All the participants were evaluated objectively by two independent rhinoplasty surgeons, and subjectively with ROE 2 years postoperatively.

RESULTS

All the participants showed significant improvement in esthetic facial evaluation postoperatively, with a correlative rise in ROE score. There was an insignificant difference between the studied groups. Inconsequential complications were encountered throughout the follow-up period, but with insignificant incidence in both groups.

CONCLUSION

Rhinoplasty for correction of RS external deformities is both safe and beneficial, with no risks of flaring up or increased complications.

LEVEL OF EVIDENCE

Level 2b.

Rhinoscleroma with Pharyngolaryngeal Involvement Caused by Klebsiella ozaenae

Rhinoscleroma is a chronic, slowly progressive granulomatous bacterial infection that is endemic to the tropical world, namely, Central America and Africa. It is occasionally seen in the United States of America (USA). It predominately affects the nasal mucosa but can also involve the rest of the upper respiratory tract. The well-known causative agent for rhinoscleroma is the bacterium Klebsiella rhinoscleromatis, a subspecies of Klebsiella pneumoniae. However, Klebsiella ozaenae can also, albeit very rarely, cause rhinoscleroma. The diagnosis is confirmed by histopathology examination that shows the characteristic Mikulicz cells, considered pathognomonic for this infection. We report a patient with histologically proven rhinoscleroma with pharyngolaryngeal involvement in whom cultures yielded Klebsiella ozaenae. To the best of our knowledge, only two cases of rhinoscleroma due to Klebsiella ozaenae have been reported in the literature to date. Our case illustrates the importance of recognizing this infection in a nonendemic setting such as the USA. A lack of awareness and a delay in the diagnosis of this disease can lead to complications including upper airway obstruction, physical deformity, and, rarely, sepsis. In addition, it must be remembered that the treatment of rhinoscleroma is challenging and requires a prolonged course of antibiotics to achieve a definite cure and avoid relapses.

Rhinoscleroma in a 5-year-old Portuguese Child

Rhinoscleroma is a chronic granulomatous infectious disease that is rare in Western Europe. We report the case of a 5-year-old Portuguese boy diagnosed with rhinoscleroma in the context of recurrent epistaxis. He had a 6-month course of antibiotic (amoxicillin plus clavulanate) therapy with full recovery.

Rhinoscleroma in an immigrant from Egypt: a case report

Rhinoscleroma is a chronic indolent granulomatous infection of the nose and the upper respiratory tract caused by Klebsiella rhinoscleromatis; this condition is endemic to many regions of the world including North Africa. We present a case of rhinoscleroma in a 51-year-old Egyptian immigrant with 1-month history of epistaxis. We would postulate that with increased travel from areas where rhinoscleroma is endemic to other non-endemic areas, diagnosis of this condition will become more common.