RHINOSCLEROMA

Causative organism:

• Chronic granulomatous disease caused by Gram negative bacillus called Klebsiella rhinoscleromatis (Frisch bacillus)

• The disease runs through the following stages:

1. Catarrhal or atrophic stage: It resembles atrophic rhinitis and is characterized by foul smelling purulent nasal discharge and crusting.
2. Granulomatous stage: Granulomatous nodules in nasal mucosa. There is also subdermal infiltration of lower part of external nose and upper lip giving a ‘woody’ feel. Nodules are painless and non-ulcerative.
3. Cicatricial stage: This causes stenosis of pares, distortion of upper lip, adhesions in the nose, nasopharynx and oropharynx. There may be subglottic stenosis with respiratory distress

 Clinical and Histologic features:

•  Rhinoscleroma may be found in all age groups, but typically young adults 20–30 years old are most frequently affected. 
• Airborne transmission combined with poor hygiene, crowded living conditions, and poor nutrition contributes to its spread.
• Subdermal infiltration of the lower part of external nose and upper lip giving a woody feel
• Miculicz’ cells (macrophages containing large amounts of bacteria-filled vacuoles) and Russell bodies (spherical structures found in the cytoplasm of plasma cells and also seen in multiple myeloma)
• Corin cells, morula cells, mott cells are also seen
• Gothic sign
• Potato nose, hebra nose, elephantiasis of nose
• Tapir nose (also in leishmaniasis)

Exam Question

Cause:

• Chronic granulomatous disease caused by Gram negative bacillus called Klebsiella rhinoscleromatis (Frisch bacillus)