A Case Report of Rhinoscleroma Treatment and Results

Abstract

Introduction: Rhinoscleroma is a rare, chronic granulomatous infection primarily caused by Klebsiella rhinoscleromatis, though Klebsiella ozaenae may also be responsible in rare instances. The disease most commonly affects the nasal cavity and nasopharynx but can extend to the larynx, trachea, bronchi, middle ear, and orbit. Histopathology typically reveals Mikulicz cells, which are pathognomonic for rhinoscleroma.

Case Description: This report highlights an unusual presentation of rhinoscleroma involving the lips and gums in a middle-aged female, although another case described an 11-year-old patient with nasal obstruction and rhinorrhea. Examination showed no bone destruction of the nasal wall. Symptoms such as epistaxis, dysphagia, nasal deformity, and soft-palate anaesthesia—causing airway obstruction—were also noted.

Etiology and Diagnosis: Klebsiella rhinoscleromatis, a subspecies of Klebsiella pneumoniae, is the primary causative organism. Rarely, Klebsiella ozaenae has been isolated in confirmed cases, with only two such instances reported in the literature. Diagnosis relies on histopathological examination (HPE) of nasal specimens or direct detection of bacteria in nasal exudates. HPE in this case revealed dense inflammatory infiltrates with lymphoplasmacytic and histiocytic cells, confirming rhinoscleroma. Mikulicz cells supported the diagnosis. Differential diagnoses include syphilis, cancer, and midline granuloma.

Management: Treatment of rhinoscleroma requires long-term antibiotic therapy. Streptomycin is the preferred drug, though cephalosporins and fluoroquinolones are effective alternatives. In this case, the patient was treated with ceftriaxone along with endoscopic excision of a nasal mass. Surgical intervention is recommended when airway obstruction or anatomical deformities are present.

Conclusion: Rhinoscleroma is a rare infection often associated with poor hygiene and low-resource conditions. Because it can mimic infectious and neoplastic disorders, early recognition through histopathology is essential. Successful management depends on prolonged antibiotic treatment combined with surgical procedures when necessary to relieve obstruction and prevent further disease progression.