Rhinoscleroma: A case report

Dr. Nikesh M GosraniENT RESIDENT,

IGGMC, NAGPUR

HISTORY12 yr old maleOf Makkatola,Chattisgadhc/o

swelling over nose- 2 months

Blocking/obstruction of nose-

2 months• Increasing gradually

HISTORYPast history - not significant

Family history - not significant

Personal history - baths in lake/boring well water

GENERAL EXAMINATIONGC- modAfebrileP-74/minBP- 120/80 mmHgNo pallor/clubbing/cyanosis/icterus/edemaCervical lymphadenopathy

Systemic ExaminationRespiratory system -NADCardiovascular system - NADGastrointestinal system - NADCentral Nervous System - NAD

LOCAL EXAMINATION

Swelling over nose extending from supratip to dorsum, between nasolabial fold horizontally.

Firm , woody on consistency

Splaying of nasal bones with telecanthus

LOCAL EXAMINATIONNose(A/R)

Bluish red mass obscurring view of both nasal cavity.

Sensitive to touch, does not bleed on touch, firm in consistency.

LOCAL EXAMINATION Oral & oropharynx: Ulcer over hard palate 0.5x0.5 cm

IDL-WNL

INVESTIGATIONSHematological investigations -WNLCT scan -small mildly enhancing

soft tissue lesion in anterior part of nasal cavity arising from superior wall and blocking the nares.

INVESTIGATIONS

PUNCH BIOPSYShows sheets of plasma cells, lymphocytes & few foamy histiocytess/o rhinoscleroma

TREATMENTPresently on Tetracyclin 500 mg tds.Recanalisation is planned after two weeks of

medical treatment.

DiscussionGranulomatous diseaseKlebsiella rhinoscleromatis, gram negative

encapsulated rod like bacillusFormation of nodules in mucosal& submucosal layer.No ulceration or suppuration.Mode of infection is unknown.4 stages: catarrhal stage

atrophic stage nodular/ granulomatous stagecicatrization

DISCUSSIONPresence of an accumulation of plasma cells, lymphocytes &

eosinophils, Miculicz cells & Russel bodies found.High content of mucopolysacchrides around walls protects

organismDifferential diagnosis: Atrohic rhinitis

TuberculosisLupus vulgaris

Diagnosis: clinical featuresCompliment fixation testCulture Biopsy

Barylak ,s technique

DISCUSSIONModalities of treatment -Antibiotics-Streptomycin -Tetracycline

-Septran -Chloramphenicol

-Local application – injection of mixture of carbolic acid, glycerine &acetic acid

-steroid -Removal of cicatrisation & recanalisation - Radiotherapy

CONCLUSIONUncommmon in present decadeRhinoscleroma should be kept in mind.