Rhinoscleroma: eight Peruvian cases

Abstract

Rhinoscleroma is a rare infection in developed countries; although, it is reported with some frequency in poorer regions such as Central Africa, Central and South America, Eastern and Central Europe, Middle East, India and Indonesia. Nowadays, rhinoscleroma may be erroneously diagnosed as mucocutaneos leishmaniasis, leprosy, paracoccidioidomycosis, rhinosporidiasis, late syphilis, neoplasic diseases or other upper airway diseases. From 1996 to 2003, we diagnosed rhinoscleroma in eight patients attended in the Dermatologic and Transmitted Diseases service of "Cayetano Heredia" National Hospital, in Lima, Peru. The patients presented airway structural alterations producing nasopharyngeal, oropharyngeal and, in one patient, laryngeal stenosis. Biopsy samples revealed large vacuolated macrophages (Mikulicz cells) in all patients. Ciprofloxacin 500 mg bid for four to 12 weeks was used in seven patients and oxytetracycline 500 mg qid for six weeks in one patient. After follow-up for six to 12 months the patients did not show active infection or relapse, however, all of them presented some degree of upper airway stenosis. These cases are reported because of the difficulty diagnosing the disease and the success of antibiotic treatment.

Rhinoscleroma: A case report

“…The disorder always begins in the nose [4]. The nose is affected in 95-100% of cases, the pharynx in 18-43%, larynx in 15-80%, trachea in 12%, and bronchi in 2-7% [5].…”

Rhinoscleroma causing severe bilateral nasal obstruction

“…12,13 Three overlapping stages were described in rhinoscleroma: catarrhal-atrophic, granulomatous (proliferative or nodular) and sclerotic (cicatricial or fi brotic). 2 Microscopically, the catarrhal/atrophic stage exhibits squamous metaplasia and a nonspecifi c subepithelial infi ltrate of polymorphonuclear leukocytes with granulation tissue. The diagnostic features are found in the granulomatous stage.…”

“…In previous study, oxytetracycline and ciprofl oxacin were used with good results and without relapse during six to 12 months of follow-up. 2 Untreated patients tend to progress to involvement of other parts of the respiratory system. In trachea the disease can lead to progressive airway obstruction, a life-threatening complication.…”

“…1 Most of the cases have been reported from many countries of the Middle East, tropical Africa, India, south-east Asia, Central and South America but, in recent years, some cases in nonendemic areas have been reported because of the increased migration of the population over the world. 2,3 We found few isolated cases described in Brazilian patients. [4][5][6][7][8] However, more than 16,000 cases have been reported from different parts of the world since 1960.…”

Rhinoscleroma in a 5-year-old Portuguese Child

“…14, 5 We report the case of rhinoscleroma in a 5-year-old previously healthy Portuguese boy, who responded completely to treatment with amoxicillin-clavulanate.…”