Rhinoscleroma Revisited

ABSTRACT Rhinoscleroma (more appropriately 'scleroma') is a chronic, disfiguring inflammatory lesion that is rarely encountered in the present-day otolaryngology practice. The diagnosis often becomes difficult especially when it recurs and presents late with complications. This report illustrates the clinical and histologic features of rhinoscleroma in a defaulter patient who represents advanced-stage disease with orbital and intracranial extensions. Special emphasis has been provided on the computed tomography impressions such that the evolution of scleroma with time can be studied.

Clinical, radiological and pathological study of 88 cases of typical and complicated scleroma.

BACKGROUND: Scleroma is a chronic specific granulomatous disease. It is considered endemic in Central America, Egypt, tropical Africa, India, and Indonesia. The most common complaint is nasal obstruction, other symptoms include; rhinorrhea, epistaxis, dysphagia, stridor, and dysphonia. AIM: So our objective was to focus on the various clinical and radiological manifestations of scleroma in an endemic area, with some atypical symptoms and signs, and to alert physicians to suspect scleroma or its complications in any case of unexplained nasal lesion. MATERIAL AND METHODOLOGY: Our study included 88 cases who were admitted in our otorhinolaryngology department. They presented with various manifestations of Rhino-pharyngo-laryngo scleroma, out of these patients 16 cases showed atypical presentations. Our diagnosis was based on clinical and radiological examination, aided by bacteriological and pathological examination. RESULTS: Patients with typical rhinoscleroma (72 patients) presented with various nasal and laryngo-tracheal symptoms. 16 patients (18%) presented complaining of various nasal symptoms and signs, which were not suspected to be rhinoscleroma, so our workup was directed to diagnose those patients, and their final diagnosis was reached to be rhinoscleroma, we sub classified those patients according to their presentation. CONCLUSION: Rhinoscleroma can present clinically with atypical features, so in order to avoid misdiagnosis, it is important to keep in mind these atypical manifestations.

[Rhinoscleroma: a report of 2 cases]. / Le rhinosclerome: a propos de deux cas.

Rhinoscleroma is a rare chronic granulomatous infection caused by Klebsiella rhinoscleromatis. Because of its mundane clinical presentation as chronic rhinits, it is frequently unrecognized. The authors report the cases of two female patients with pseudotumoral rhiniscleromas located in the septum and in the rhinopharynx respectively CT scan permitted a precise evaluation of the extent of the lesion. Among the various para-clinical examinations required, bacteriological studies are very important and should be performed comcomitantly with biopsy.

[Rhinoslceroma in an elderly Danish woman]. / Rhinoscleroma hos en aeldre dansk kvinde.

A case of rhinoscleroma in an elderly Danish woman is presented. The characteristics of the disease are described. An 84-year old female presented with serous rhinorrhoea, swelling of the columella and the upper lip and granulomatous masses in the right inferior concha and the right maxillary sinus. The diagnosis was confirmed by histological studies. Until now no serological or bacteriological cultures have been positive. The patient recovered clinically after surgical debridement and three months of orally administered ciprofloxacin 500 mg twice daily. There remains, however, a sclerotic swelling in the columella and the upper lip. No obvious explanation as to how this patient had caught the disease could be found.

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.

CT findings in a case of pharyngeal rhinoscleroma.

The author describes the infectious disease rhinoscleroma and calls for its consideration in the differential diagnosis of nasal, pharyngeal, and tracheal masses seen in young immigrants.

Antroscopy in rhinoscleroma.

Rhinoscleroma is a chronic specific granulomatous inflammatory condition that has an affinity to the mucosa of the upper respiratory tract. Involvement of maxillary antrum is said to be very uncommon. In the present study antroscopy was performed in 20 patients with rhinoscleroma to find out the type, nature and site of the lesion in the maxillary antrum. The maxillary antrum was involved in 60 per cent of cases with rhinoscleroma. The lesions occurred in the form of atrophic changes, granuloma, and the fibrotic thick healed stage. The anterior-inferior part and medial wall of the antrum are found to be more commonly affected. It is suggested that involvement of maxillary antrum in scleroma may act as a reservoir of infection and such patients may therefore take a longer time to respond to antibiotic therapy.

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.