Rhinoscleroma

• Rhinoscleroma, or simply scleroma, is a chronic granulomatous bacterial disease of the nose that can sometimes infect the upper respiratory tract.
•  It most commonly affects the nasal cavity—the nose is involved in 95–100 per cent of cases—however, it can also affect the nasopharynx, larynx, trachea, and bronchi.
• Slightly more females than males are affected and patients are usually 10 to 30 years of age.

Signs and symptoms

• Rhinoscleroma has been divided into 3 stages: catarrhal/atrophic, granulomatous, and sclerotic stages.
• The catarrhal stage begins with a nonspecific rhinitis, which progresses into purulent, fetid rhinorrhea, and crusting, which can last for weeks or even months.
• The granulomatous stage results in the development of a bluish red nasal mucosa and the development of intranasal rubbery nodules or polyps.
•  Nose bleeds, nasal deformity, and destruction of the nasal cartilage are also noted (Hebra nose).

• Rhinoscleroma is caused by the gram-negative coccobacillus K rhinoscleromatis.

The disease begins in areas of epithelial transition such as the vestibule of the nose, the subglottic area of the larynx. It resembles atrophic rhinitis in atrophic stage. Subdermal infiltration of lower part of external nose and upper lip gives a ‘woody’ feel. 

The classic biopsy findings compatible with rhinoscleroma include Mikulicz cells, macrophages containing large amounts of bacteria-filled vacuoles, and Russell bodies, spherical structures found in the cytoplasm of plasma cells. 

Mikulicz cells are large mononuclear histiocytes with vacuolated cytoplasm containing causative bacilli and Russell bodies are homogenous eosinophilic inclusion bodies found in the plasma cells.

In rhinoscleromatosis, organism may be difficult to eradicate, despite aggressive therapy.

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 and inexpensive for patients unless contraindicated.

Fluoroquinolones may be used as an alternative, given their excellent gram-negative activity and convenient dosing regimen

Ans. C [Presents as a nasal polyp]

1. Rhinosporidiosis – It is fungal granuloma caused by Rhinosporidium seeberi.
2. The disease mostly affects nose and nasopharynx
3. The disease is acquired through contaminated water of ponds and cow-pets
4. Presents as a leafy, polypoidal mass, pink to purple in colour and attached to nasal septum or lateral wall, sometimes it extends into the nasopharynx and may hang behind the soft palate
5. The mass is very vascular and bleeds easily on touch its surface is studded with white dots representing the sporangia of fungus
6. Early stages complains of nasal discharge which is often blood-tinged or nasal stuffiness Sometimes frank epistaxis is the only presenting complaint
7. Diagnosis is made by biopsy, not possible to culture
8. Treatment – complete excision of the mass with diathermy knife and cauterization of its base, Dapsone has been tried with some success.

Rhinoscleroma is a rare chronic (slowly progressive) inflammatory condition caused by bacteria called Klebsiella rhinoscleromatis.

Nasopharyngeal angiofibroma is a histologically benign but locally aggressive vascular tumor of the nasopharynx that arises from the superior margin of the sphenopalatine foramen and grows in the back of the nasal cavity.

It most commonly affects adolescent males (because it is a hormone-sensitive tumor).

Though it is a benign tumor, it is locally invasive and can invade the nose, cheek, orbit (frog face deformity), or brain .

Patients with nasopharyngeal angiofibroma usually present with one-sided nasal obstruction with profuse epistaxis.

Ans. is ‘c’ i.e., Klebsiellarhinoscleromatis infection

Rhinoscleroma

• The causative organism is Klebsiellarhinosclerontatisor Frisch bacillus, which can be cultured from the biopsy material.
• The disease is endemic in several parts of world.
• In India, it is seen more often in northern than in the southern parts.
• Biopsy shows infiltration of submucosa with plasma cells, lymphocytes, eosinophils, Mikulicz cells & Russell bodies.
• The latter two are diagnostic features of the disease.
• The disease starts in the nose & extends to nasopharynx, oropharynx, larynx, trachea & bronchi.
• Mode of infection is unknown.
• Both sexes of any age may be affected.