Rhinosleroma – 12 Previous Year DNB Question for Practice


  • Rhinoscleroma is a progressive granulomatous disease of the upper respiratory tract.
  • It is caused by the gram-negative coccobacillus K rhinoscleromatis or Frish Bacillus.
  • The disease probably begins in areas of epithelial transition such as the vestibule of the nose, the subglottic area of the larynx, or the area between the nasopharynx and oropharynx. 
  • It is a chronic infection of the nose characterised by sclerosis and stenosis of the nasal passage.
  • Rhinoscleroma may be found in all age groups, but typically young adults 20–30 years old are most frequently affected.
  •  Both sexes are equally affected.
  • The disease is endemic in several parts of world.
  • In India, it is seen more often in northern than in the southern parts.
  •  Airborne transmission combined with poor hygiene, crowded living conditions, and poor nutrition contributes to its spread.


  • The disease is characterized by presence of granulations which infiltrate the submucosa ,with scattered Mikulicz cells(large vacuolated foamy cells containing a central nucleus and acid fast Frisch bacilli),Rusell bodies(resmbling plasma cells with an eccentric nucleus and deep eosin staining cytoplasm) and lymphocytes in dense fibrous tissue.



  • Blocking of the nose,Nasal Discharge,Headache,Epistaxis


  • External nose is firm and woody to touch.
  • Anterior Rhinoscopy:
    1. 3 stages:
    2. Atrophic Stage:is present initially,with crusting ,roomy cavity and atrophic dry nasal mucosa.
    3. Nodular stage:Bluish red non-ulcerative polypoidal masses of rubbery consistency are formed.
    4. Fibrotic stage of stenosis:of the nasal passages varying from partial obstruction to total atresia .
  • Throat:may show extension of the sclerosing process downwards from the nose to the oropharynx,larynx.


  • In rhinoscleromatosis, organism may be difficult to eradicate, despite aggressive therapy.Relapses may occur.
  • A combination of conservative surgical debridement and long-term antibiotic coverage is the mainstay of therapy for rhinoscleroma.
  • Tetracycline has been shown to be effective.
  • Fluoroquinolones may be used as an alternative, given their excellent gram-negative activity and convenient dosing regimen

Exam Question of

  • Mikulicz cells and Russell bodies are seen in Rhinoscleroma.
  • A roomy nasal cavity and atrophic dry nasal mucosa with thick crust formation and woody hard external nose is seen in Rhinoscleroma.
  • Rhinoscleroma is caused by Klebsiella Rhinoscleromatis.
  • Rhinoscleroma is a slowly progressing granulomatous disease.
  • Rhinoscleroma is most common in young adults 20–30 years old.
  • Poor nutrition contributes to the spread of Rhinosleroma.
  • Drug of choice in Rhinoscleromatosis is Tetracycline.
  • Frish bacillus causes Rhinoscleroma.

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