Rhinoscleroma of the lower respiratory tract.

Rhinoscleroma is a chronic granulomatous disease of the respiratory tract endemic to Eastern Europe and Central America which is being recognized with increasing frequency in other countries, including the United States. It was initially described as a lesion of the nose and upper respiratory tract, but is now known to involve the larynx, trachea and bronchi as well to cause slowly progressive asphyxia. Eleven cases of rhinoscleroma with varying degrees of involvement of the lower respiratory tract (larynx, trachea and bronchi) are presented. Present day treatment is both medical, consisting primarily of streptomycin and tetracycline, and endoscopic dilatation. Prolonged medication with careful dose control is necessary. Lower respiratory tract involvement should be considered in patients with chronic destructive granulomatous nasal pathology. This should be especially emphasized if they have an Eastern European or Central American background, or have travelled in these areas in which rhinoscleroma is endemic.

Experimental scleroma. A histopathological study.

Klebsilla rhinoscleromatis suspension was experimentally inoculated into the nose and maxillary sinus of eight adult healthy rabbits. Two normal litter-mates served as controls. The animals were killed at varying intervals up to five months following the inoculation. Histopathological examination of the upper and lower respiratory tracts revealed a consistent pulmonary peribronchial and perivascular granulomatous reaction with a Mikulic cell-like appearance. The reaction was present in all the inoculated rabbits and increased in severity as the survival period was prolonged. The significance of these findings in the aetiopathogenesis of scleroma and to scleroma in humans is discussed.

Scleroma in Uganda: a review of 85 cases.

Biopsy and autopsy protocols revealed that between 1972 and 1981, 85 cases of scleroma were diagnosed in Uganda. The disease was found to affect females more than males, and was found to be more common in the middle aged. Scleroma occurred in the nose in 96% of cases and presented commonly at a late stage. The disease was found commonly among the tribes of south western Uganda and Itesot in the east. Possible factors associated with the distribution of this disease in Uganda are discussed.

[Giant rhinoscleroma]. / Rhinosclérome géant.

UNLABELLED: Rhinoscleroma is a chronic granulomatous respiratory tract disease. The initial lesion site is often intra-nasal. Giant tumor presentations are rare. The authors report a case of extensive nasal rhinoscleroma. OBSERVATION: A 35-year-old African male patient consulted for a large tumor of the nose. The tumor had appeared 25 years before; the initial lesion site was intra-nasal. It presented as a small non-obstructive growth. The tumor was removed 20 years before, and recurred in an exophytic presentation. The main tumor was associated to peripheral, peri-nasal, and upper lip nodules. There was a central granuloma, bleeding on contact. Nasal obstruction was complete. The histological and bacteriological examination of a biopsy specimen confirmed the diagnosis of rhinoscleroma. Trimethoprim-sulfamethoxazole was effective on the infection. DISCUSSION: Rhinoscleroma is frequently located on the nasal mucosa, but extra-nasal giant tumor presentations are rare. It can involve the whole respiratory tract. It is endemic in developing countries. Sporadic cases have been described in non-endemic areas, among migrants. The diagnosis is proved by histology. Specific and early antibiotic therapy is effective. It avoids surgical mutilation, sequels, and recurrence.

Imaging of scleroma in the head and neck.

We review the appearance of scleroma in the head and neck on imaging. Scleroma is a chronic granulomatous disease that primarily affects the nasal cavity, but the pharynx and larynx may also be involved. On imaging, nasal scleroma appears as bilateral or unilateral expanded homogeneous nasal masses that may exhibit hyperintense signal on T(1) weighted images. Pharyngeal scleroma commonly narrows the pharyngeal lumen and may involve the soft and hard palate. Imaging is essential to detect the extent of subglottic stenosis in patients with laryngeal scleroma. Rarely, scleroma may involve the orbit or the middle ear. Imaging is essential for the early diagnosis of scleroma and for differentiating it from other granulomatous and neoplastic lesions. Also, imaging is important for treatment planning and follow-up of patients after therapy.

Rhinoscleroma in an immigrant from Egypt: a case report.

Rhinoscleroma is a chronic indolent granulomatous infection of the nose and the upper respiratory tract caused by Klebsiella rhinoscleromatis; this condition is endemic to many regions of the world including North Africa. We present a case of rhinoscleroma in a 51-year-old Egyptian immigrant with 1-month history of epistaxis. We would postulate that with increased travel from areas where rhinoscleroma is endemic to other non-endemic areas, diagnosis of this condition will become more common.

Evolution of nasal mucosal lesions in leprosy (histological study).

Four stages of nasal pathology in tuberculoid leprosy is described. In every atrophic rhinitis case nasal biopsy is advocated. Rhinoscopic examination should be done in family contacts and early cases of leprosy.

Klebsiella rhinoscleromatis: a clinical and pathogenic enigma.

Rhinoscleroma is a chronic, slowly progressive, infectious disease of the respiratory tract that can produce disability and death, if untreated. Once considered an anomaly in the United States, the disease is now seen more frequently in this country, owing to increased travel from endemic areas. This report presents a comprehensive review of the several types of therapy that have been published in the literature. The results of a clinical experiment are also presented.