Respiratory scleroma: A clinicopathologic study of 51 cases from Guatemala

Abstract

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.

Unusual Laryngotracheal Manifestation of Rhinoscleroma in a Pediatric Migrant Patient

“… 2 , 4 Nonetheless, tracheostomies were at times necessary to secure the airway in published accounts involving late-stage disease presentations. 1 - 4 …”

“…1,2 While several reports of rhinoscleroma have been detailed in endemic regions, including Central America, tropical Africa, Eastern Europe, and Southeast Asia, few cases have been reported in the United States. [1][2][3] Herein, we report a case of rhinoscleroma with widespread laryngotracheal involvement in an unaccompanied pediatric migrant patient. This report was exempt from UCLA internal review board review.…”

“…1 , 2 While several reports of rhinoscleroma have been detailed in endemic regions, including Central America, tropical Africa, Eastern Europe, and Southeast Asia, few cases have been reported in the United States. 1 - 3 …”

Topical ciprofloxacin as treatment for rhinoscleroma in a series of 23 patients

“…The epidemiology, transmission and pathophysiology of rhinoscleroma are still uncertain, with no consensus on treatment 3 . Many treatment modalities were tried, but none of them has proved to achieve complete unrelapsed cure of the disease 4 . Here we investigated outcomes in a case series of patients with the novel approach of treatment with topical ciprofloxacin.…”

“…3 Many treatment modalities were tried, but none of them has proved to achieve complete unrelapsed cure of the disease. 4 Here we investigated outcomes in a case series of patients with the novel approach of treatment with topical ciprofloxacin.…”