Rhinoscleroma: an interesting differential diagnosis

Correlation Between Nasal and Laryngeal Lesions of Rhinoscleroma in Patients of Upper Egypt

INTRODUCTION

Rhinoscleroma (RS) is a chronic granulomatous disease of URT caused by Klebsiella Rinoescleromatis. RS is considered endemic in Egypt. The nasal mucosa represents the primary region of occurrence. The disease can potentially spread to involve the larynx and trachea causing dysphonia, stridor, and airway obstruction.

OBJECTIVES

To describe various nasal and laryngeal presentations of RS in our endemic area, to correlate between these findings and to alert physicians to suspect RS in any case of unexplained nasal or laryngeal lesion.

METHODS

The study included 100 patients admitted in our otorhinolaryngolgy department (Minia University, Minia, Egypt). Patients presented with various manifestations of Rhino-pharyngo-laryngo scleroma. Diagnosis based on clinical, bacteriological, and pathological examination.

RESULTS

Patients had typical nasal stages of RS, however; only 12 % of patients had the typical described laryngeal presentations (ie, subglottic narrowing and subglottic membrane). Other patients presented with atypical laryngeal presentations (eg, unhealthy vocal folds, ventricular fold hypertrophy, and suproglottic sticky greenish discharge). There was significant correlation between nasal stages and laryngeal lesions.

CONCLUSION

RS can present with atypical laryngeal presentations in endemic areas which should be kept in mind to avoid misdiagnosis. Possible laryngeal lesions of RS can be predicted from observing associated nasal lesions.

Rhinoscleroma

CONTEXT.—

Rhinoscleroma is a rare, chronic, infectious granulomatous process involving the upper respiratory tract caused by gram-negative bacilli, Klebsiella rhinoscleromatis. The site most commonly affected is the nasopharynx; however, lesions in various other locations have been described.

OBJECTIVE.—

To review the literature for all the reported cases of rhinoscleroma in the past 5 years.

DATA SOURCES.—

Published cases of rhinoscleroma from a PubMed (National Center for Biotechnology Information, Bethesda, Maryland) search were reviewed.

CONCLUSIONS.—

Rhinoscleroma in nonendemic regions is extremely rare; however, with increased travel, immigration, and globalization, it is imperative to recognize this entity because the symptoms can be devastating and in some cases fatal. Although nasopharynx is the common site of involvement, unusual sites such as the trachea can be involved in rare cases. Rhinoscleroma can be managed effectively with a combination of antibiotics and surgical debridement and repair; however, recurrence rates do remain high.

[Laryngeal stenosis as late manifestation of rhinoscleroma. Case report]

Rhinoscleroma is a chronic, progressive, granulomatous disease resulting from infection with Klebsiella rhinoscleromatis. It is generally uncommon, but endemic in certain regions of the world. It typically affects the nasal cavity, but also other parts of the respiratory system, such as the laryngotracheal region, which may be life-threatening if compromised. We present a 46-year-old male patient with a history of rhinoscleroma diagnosed and treated 15 years ago, with subglottal stenosis as a late sequela of this disease.

[Tracheal scleroma and rhinoscleroma: a case report]

Scleroma is a specific granlomatous disease caused by an enterobacteria of the Klebsiella family (Klebsiella rhinoscleromatis), localized electively in the upper airways, particularly the nasal fossae, leading to the term "rhinoscleroma". Tracheal involvement is exceptional. The disease progresses slowly, leaving mutilating and stenosing scar tissue. Medical treatment using antibiotics and corticosteroids is the basic approach although surgical treatment may be needed for fibrosclerosis unresponsive to medical treatment. We report a case of rhinoscleroma which extended to the trachea. In light of this case, we examine the demographic, diagnostic, therapeutic and evolutive aspects of this disease.