Airway scleromas and their extensions

Rhinoscleroma Masquerading as a Nasopharyngeal Malignancy

Klebsiella rhinoscleromatis, the causative agent of rhinoscleroma, is a Gram-negative, facultative intracellular, non-motile, encapsulated bacillus. The organism has a very low infectivity necessitating a chronic exposure for infection. Prevalence is also high in developing countries like India. The factors responsible for this are attributed to poor hygiene, poor access to medications and overcrowded living conditions.1 Though entire respiratory mucosa can be affected, the organism has an affinity for nasal mucosa and thus nasal cavity is the most prevalent site accounting for 95–100 % of cases. In decreasing order of involvement nasopharynx (18 – 43 %), larynx (15 – 40 %), trachea (12 %) and bronchi (2 – 7 %) are the other sites.2 Our patient had bilateral nasal obstruction and discharge since 6 months as the only presenting complaint. Clinically there was no evidence of lymphadenopathy, but the CT scans of the paranasal sinuses showed heterogeneously ill-defined mass in the posterior nasal cavity, raising suspicion of a malignancy. Hence the case was further investigated.

Respiratory scleroma: A clinicopathologic study of 51 cases from Guatemala

OBJECTIVES

To evaluate clinical and pathologically cases of respiratory scleroma diagnosed in a 30-year period in Guatemala.

MATERIAL AND METHODS

Fifty-one cases of respiratory scleroma diagnosed from 1988 to 2018 in a single pathology service in Guatemala were confirmed using Warthin-Starry staining. Immunohistochemical reactions against CD68, LCA, CD20, CD3, and CD138 were performed to illustrate the inflammatory infiltrate. Scanning electron microscopy (SEM) was performed to illustrate bacteria morphology.

RESULTS

All 51 cases affected patients from poor areas of Guatemala, particularly women (66.7%), with a mean age of 31 years (range 7-66 years). Nose was affected in most cases (96.1%). Other sites involved included pharynx, larynx, palate, maxillary sinuses, and upper lip. Depending on the stage, the disease manifested as ulcerations, nasal deformities, or laryngeal stenosis. Nasal obstruction, epistaxis, dysphonia, fetid discharge, and pain were the main symptoms. Mikulicz cells (CD68+) in a plasma cell-rich inflammatory background (CD138+, CD20+, CD3+/-) were the typical microscopic presentation. In SEM, each macrophagic vacuole contained few to dozens of Klebsiella rhinoscleromatis diplobacilli. Treatment consisted of long-term trimethoprim and sulfamethoxazole, with adequate control of disease.

CONCLUSION

Respiratory scleroma is a rare infectious disease affecting the upper respiratory tract, in poor regions of the world, including Guatemala.

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.