RESUMEN
Rhinoscleroma (RS) is a rare chronic specific progressive granulomatous disease of the upper airway and affect the nasal cavity, larynx, nasopharynx and may spread to the lower respiratory tract. Extra-respiratory involvement has rarely been described. A case report of extra-respiratory RS with oral manifestation in Egyptian female patient has been presented as a tumour extruded from mucosal lining of upper lip. She was living in crowded conditions with malnutrition and poor hygiene. On the first look, the lesion appeared to be carcinoma without any indication of infectious disease, and then patient was prepared for incisional biopsy. Upon clinicopathological evaluation, the diagnosis was made as RS in the granulomatous stage based on the presence of dense plasma cell infiltration with Mikulicz cells and Russell bodies. Long term oral ciprofloxacin 500 mg twice/day was started as a single treatment. By the end of six weeks antibiotic therapy, the large granulomatous mass reached the cicatricial stage, became very stiff fibrotic mass with sclerotic scar, markedly indurated & significantly decreased in size. This case shows the significant of through clinical examination and lab investigations to achieve correct diagnosis.
Asunto(s)
Rinoscleroma , Ciprofloxacina/uso terapéutico , Femenino , Humanos , Cavidad Nasal/patología , Nariz , Patología Bucal , Rinoscleroma/diagnóstico , Rinoscleroma/patología , Rinoscleroma/terapiaRESUMEN
Scleroma is a chronic infectious disease characterized by developing inflammation nye granulomas, mainly of the upper respiratory tract, with subsequent scarring. The reasons for the development of scleroma remain unclear, but it is generally accepted that the gram-negative coccal bacterium Klebsiella rhinoscleromatis (pas-Volkovich's loch - Frisch) is the causative agent of this disease. Endemic in the spread of scleroma is considered There are tropical and temperate zones such as Africa, Asia, Eastern Europe, South America and Central America. Features of development scleroma in the present case and the complexity of the diagnosis caused by atypical, the rapid development of the disease, the greater prevalence of the process (including the orbit), with the transition to the soft tissues of the cheek bone and upper jaw, which is not typical for scleroma. The process was primarily localized in the left maxillary sinus and mimicked sinusitis. The presence of radicular cysts and darkening of the left maxillary sinus on radiographs, taking into account the clinical picture of the disease, were interpreted incorrectly, which led to the establishment of an incorrect diagnosis and subsequent surgical interventions. More targeted and consistent examination of histo-the logical material obtained after three surgical interventions made it possible to identify the characteristic signs scleroma, establish the correct diagnosis and prescribe effective treatment. In our case, we applied Ciprofloxacin course for 3 months at a maximum daily dose of 2000 mg in combination with probiotics. During treatment, it was noted a significant improvement in the patient's well-being, facial pains became less intense, a decrease in the volume of ma tissues of the left cheek and improved nasal breathing.
Asunto(s)
Laringe , Rinoscleroma , Humanos , Klebsiella pneumoniae , Nariz , Rinoscleroma/complicaciones , Rinoscleroma/diagnóstico , Rinoscleroma/terapiaRESUMEN
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.
Asunto(s)
Enfermedades Respiratorias/diagnóstico , Enfermedades Respiratorias/microbiología , Rinoscleroma/diagnóstico , Rinoscleroma/microbiología , Adolescente , Adulto , Anciano , Niño , Femenino , Guatemala , Humanos , Klebsiella pneumoniae/aislamiento & purificación , Klebsiella pneumoniae/ultraestructura , Macrófagos/microbiología , Microscopía Electrónica de Rastreo , Persona de Mediana Edad , Obstrucción Nasal , Enfermedades Respiratorias/patología , Rinoscleroma/patología , Adulto JovenRESUMEN
Introduction: Scleroma is a rare chronic granulomatous disease of the upper respiratory tract caused by Klebsiella pneumoniae subsp. rhinoscleromatis. To date its pathogenesis is as yet little understood. At the same time, scleroma is associated with a number of immune system disturbances. The aim: To study local immunity status of oropharynx in patients with scleroma, and to compare its parameters in various clinical forms of the disease. Material and methods: 20 apparently healthy subjects and 92 patients with scleroma (33 males, 59 females) underwent clinical immunologic evaluation. There were 31 patients with dominating infiltrative form of scleroma, 30 with dominating atrophic form, 31 with dominating scarring form. Concentration of secretory and monomeric immunoglobulin A, immunoglobulin G, α-interferon, interleukin 1ß in oropharyngeal secretion was determined by enzyme immunoassay. Resluts: Patients with scleroma were found to have altered local immunity of oropharyngeal secretion. There was a strong tendency for decreased concentration of secretory immunoglobulin A - 1.3-2.0 times, and decreased immunoglobulin G level 1.5-2.3 times (Ñ < 0.05) as compared to the values in healthy subjects. Specific features of local immunity in oropharyngeal secretion in various forms of scleromatous inflammatory process in upper respiratory tract were found: the most significant decrease of α-interferon concentration in atrophic and scarring forms of the disease, and the largest increase of anti-inflammatory interleukin 1ß and immune complex concentration in infiltrative form of scleroma. Conslusions: The study revealed deficiency of local immunity factors in oropharynx, being indicative of immunopathogenetic role of diagnosed disturbances in development and persistence of chronic inflammation in scleroma, and emphasizing the necessity of immunocorrection in complex therapy of the disease.
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Laringe , Rinoscleroma , Femenino , Humanos , Klebsiella pneumoniae , Masculino , Nariz , OrofaringeAsunto(s)
Pestañas/patología , Lepra Lepromatosa/diagnóstico , Nariz/patología , Rinoscleroma/diagnóstico , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Biopsia/métodos , Quimioterapia Combinada , Eritema/diagnóstico , Eritema/patología , Femenino , Humanos , Klebsiella pneumoniae/aislamiento & purificación , Leprostáticos/uso terapéutico , Lepra Lepromatosa/complicaciones , Lepra Lepromatosa/microbiología , Lepra Lepromatosa/patología , Perdida de Seguimiento , Persona de Mediana Edad , Mycobacterium leprae/aislamiento & purificación , Rinoscleroma/etiología , Rinoscleroma/microbiología , Rinoscleroma/patologíaAsunto(s)
Edema/diagnóstico , Pólipos Nasales/diagnóstico , Enfermedades Nasales/diagnóstico , Rinoscleroma/diagnóstico , Anosmia/diagnóstico , Anosmia/patología , Edema/patología , Edema/terapia , Dolor Facial/diagnóstico , Dolor Facial/patología , Femenino , Fiebre/diagnóstico , Fiebre/patología , Cefalea/diagnóstico , Cefalea/patología , Humanos , Persona de Mediana Edad , Mucosa Nasal/patología , Pólipos Nasales/patología , Pólipos Nasales/terapia , Enfermedades Nasales/patología , Enfermedades Nasales/terapia , Rinoscleroma/patología , Rinoscleroma/terapiaRESUMEN
Rhinoscleroma is a rare chronic granulomatous infectious disease and important differential diagnosis in developing countries and emigrants from these regions. In this survey we present seven cases from University Hospital Kigali, Rwanda, and one more from Germany. All cases are discussed on the background of the current literature.
Asunto(s)
Rinoscleroma/diagnóstico , Rinoscleroma/terapia , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Rinoscleroma/complicaciones , Adulto JovenRESUMEN
To evaluate the role of MR imaging in patients with laryngoscleroma. We retrospectively reviewed the MR imaging of 14 patients (11 female, 3 male with mean age of 31 years) with pathologically proven laryngoscleroma. They presented with dysphonia (n = 12), stridor (n = 8) and airway obstruction (n = 4). They underwent T1- and T2-weighted MR images and post contrast study after injection of 0.1 mmol Gd/DTPA. Laryngoscleroma was seen in the subglottic (n = 13) and supraglottic (n = 1) regions. Laryngoscleroma at granulomatous stage (n = 6) appeared as diffuse circumferential soft tissue mass with high (n = 4) or mixed (n = 2) signal intensity on T2-weighted images with homogenous (n = 4) and inhomogeneous (n = 2) pattern of contrast enhancement. At fibrotic stage (n = 8), laryngoscleroma was seen as diffuse asymmetrical circumferential thickening of the subglottic region with low signal intensity on T2-weighted images and mild contrast enhancement. Subglottic lesions encircled the subglottic region with marked (n = 5) and mild (n = 9) narrowing of the airway with variable degree of extension into the trachea in three patients. There was diffuse thickening of the epiglottis, aryepiglottic folds in one patient with supraglottic scleroma. MR imaging is a non-invasive imaging modality for accurate localization, extension and staging of laryngoscleroma. These data is important for treatment planning.
Asunto(s)
Enfermedades de la Laringe/diagnóstico , Rinoscleroma/diagnóstico , Adolescente , Adulto , Obstrucción de las Vías Aéreas/diagnóstico , Obstrucción de las Vías Aéreas/etiología , Medios de Contraste , Disfonía/diagnóstico , Disfonía/etiología , Femenino , Gadolinio DTPA , Humanos , Enfermedades de la Laringe/complicaciones , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Ruidos Respiratorios/diagnóstico , Ruidos Respiratorios/etiología , Estudios Retrospectivos , Rinoscleroma/complicaciones , Adulto JovenRESUMEN
OBJECTIVE: To study the prevalence of IgG4-positive plasma cells in inflammatory disease of nasal cavity and paranasal sinuses and its association with IgG4-related sclerosing disease (IgG4-SD). METHODS: The expression of IgG4 and IgG in plasma cells of 103 cases diagnosed as inflammatory disease of nasal cavity and paranasal sinuses with dense lymphoplasmacytic infiltrate was studied by immunohistochemistry (EnVision) and quantitatively analyzed by medical image analysis system. RESULTS: Immunohistochemical study showed marked infiltration by IgG4-positive plasma cells (>50 per high-power field) in 28 cases, moderate infiltration (30 to 50 per high-power field) in 23 cases, mild (10 to 29 per high-power field) in 30 cases and negative (<10 per high-power field) in 22 cases (P < 0.05). Twenty-two cases studied fulfilled the diagnostic criteria of IgG4-SD (>50 IgG4-positive plasma cells per high-power field and IgG4-to-IgG ratio > 40%), including 3 cases of chronic sinusitis (3/20), 3 cases of nasal polyps (3/18), 3 cases of inflammatory pseudotumor (3/17), 4 cases of fungal sinusitis (4/20), 1 case of rhinoscleroma (1/12), 7 cases of Wegener's granulomatosis (7/11) and 1 case of Rosai-Dorfman disease (1/2). CONCLUSION: Inflammatory disease of nasal cavity and paranasal sinuses fulfilling the diagnostic criteria IgG4-SD is not uncommon. Definitive diagnosis of IgG4-SD requires correlation with other clinical and laboratory findings. Some cases of unexplained inflammatory disease of nasal cavity and paranasal sinus may represent a member of the IgG4-SD spectrum. IgG4 carries diagnostic value in differential diagnosis of inflammatory disease occurring in nasal cavity and paranasal sinuses.
Asunto(s)
Inmunoglobulina G/metabolismo , Cavidad Nasal , Enfermedades Nasales , Enfermedades de los Senos Paranasales , Senos Paranasales , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Diagnóstico Diferencial , Femenino , Granuloma de Células Plasmáticas/metabolismo , Granuloma de Células Plasmáticas/patología , Granulomatosis con Poliangitis/metabolismo , Granulomatosis con Poliangitis/patología , Histiocitosis Sinusal/metabolismo , Histiocitosis Sinusal/patología , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Cavidad Nasal/inmunología , Cavidad Nasal/patología , Pólipos Nasales/metabolismo , Pólipos Nasales/patología , Enfermedades Nasales/inmunología , Enfermedades Nasales/patología , Enfermedades de los Senos Paranasales/inmunología , Enfermedades de los Senos Paranasales/patología , Senos Paranasales/inmunología , Senos Paranasales/patología , Células Plasmáticas/inmunología , Rinoscleroma/metabolismo , Rinoscleroma/patología , Sinusitis/metabolismo , Sinusitis/patología , Adulto JovenRESUMEN
INTRODUCTION: Rhinoscleroma (RS) is a chronic granulomatous disease of URT caused by Klebsiella Rinoescleromatis. RS is considered endemic in Egypt. The nasal mucosa represents the primary region of occurrence. The disease can potentially spread to involve the larynx and trachea causing dysphonia, stridor, and airway obstruction. OBJECTIVES: To describe various nasal and laryngeal presentations of RS in our endemic area, to correlate between these findings and to alert physicians to suspect RS in any case of unexplained nasal or laryngeal lesion. METHODS: The study included 100 patients admitted in our otorhinolaryngolgy department (Minia University, Minia, Egypt). Patients presented with various manifestations of Rhino-pharyngo-laryngo scleroma. Diagnosis based on clinical, bacteriological, and pathological examination. RESULTS: Patients had typical nasal stages of RS, however; only 12 % of patients had the typical described laryngeal presentations (ie, subglottic narrowing and subglottic membrane). Other patients presented with atypical laryngeal presentations (eg, unhealthy vocal folds, ventricular fold hypertrophy, and suproglottic sticky greenish discharge). There was significant correlation between nasal stages and laryngeal lesions. CONCLUSION: RS can present with atypical laryngeal presentations in endemic areas which should be kept in mind to avoid misdiagnosis. Possible laryngeal lesions of RS can be predicted from observing associated nasal lesions.
Asunto(s)
Laringe , Rinoscleroma , Egipto/epidemiología , Humanos , Laringe/patología , Nariz , Rinoscleroma/diagnóstico , Rinoscleroma/epidemiología , Rinoscleroma/patología , Tráquea/patologíaRESUMEN
Extranodal natural killer/T-cell lymphoma, nasal type (ENKL) is a rare and aggressive tumor that can mimic inflammatory conditions and other tumors, and present a diagnostic challenge. We report a 57-year-old Chinese man previously misdiagnosed with rhinoscleroma. The patient had undergone multiple biopsies when the histopathological diagnosis of ENKL was made. Because the diagnosis may be obscured by extensive necrosis, multiple biopsies are necessary to make a certain diagnosis. According to the diagnosis process of this patient, the need to consider a neoplastic cause should be highlighted when faced with an aggressive nasal disease not responsive to maximal treatment.
Asunto(s)
Linfoma Extranodal de Células NK-T , Enfermedades Nasales , Rinoscleroma , Humanos , Células Asesinas Naturales , Ganglios Linfáticos , Linfoma Extranodal de Células NK-T/diagnóstico , Masculino , Persona de Mediana Edad , Rinoscleroma/diagnósticoRESUMEN
Rhinoscleroma is a chronic inflammatory disease in which granulation tissue with a typical cell content is found. The paper presents the case of a 77-year-old woman with clinically diagnosed nodule in the nasal cavity. The histopathological examination revealed granulation tissue with plasma cells and Mikulicz's cells. The clinical and morphological picture of the case in question is a rare opportunity to bring to mind a disease that used to be common in Poland and which clinically can imitate malignant tumour.
Asunto(s)
Cavidad Nasal/patología , Rinoscleroma/patología , Anciano , Antígenos CD/metabolismo , Antígenos de Diferenciación Mielomonocítica/metabolismo , Biomarcadores/metabolismo , Femenino , Tejido de Granulación/metabolismo , Tejido de Granulación/microbiología , Tejido de Granulación/patología , Humanos , Klebsiella pneumoniae/aislamiento & purificación , Cavidad Nasal/metabolismo , Cavidad Nasal/microbiología , Células Plasmáticas/metabolismo , Células Plasmáticas/patología , Rinoscleroma/metabolismo , Rinoscleroma/microbiología , Sindecano-1/metabolismoRESUMEN
The ELISA were performed on polystyrene microtiter plates (Nunc, MaxiSorp) coated with LPS (2a antigen) at the final concentration of 10 microg/ml. The antigen was extracted from Klebsiella rhinoscleromatis Rh32 by the trichloroacetic acid and separated by ethanol (Boivin method). The antibodies against the LPS were detected by ELISA in serum samples collected from 65 patients suspected in clinical investigation for rhinoscleroma in Poland from 1970 to 2009. Additionally, the specificity of the antigen was tested using serum sample of immunized rabbit and 30 sera of patients from control group, with high level of antibodies to different bacterial pathogens. All serum samples were diluted 1:100. The concentrations of IgA, IgG and IgM antibodies were expressed as optical density (OD) measured at the wavelength of 450 nm. The cut-off limit of serum antibodies was set at mean antibody OD determined in the sera of 30 blood donors exceeded by three standard deviations. The presence of IgA and IgG antibodies were detected by ELISA in 33 (50,8%) and IgM in 28 (43,1%) of patients. Most of the serum samples (75%) with high level of specific antibodies were obtained from patients before 1980. On the other hand antibodies to K. rhinoscleromatis were detected only in 2 (6,7%) patients from the control group and none of blood donors. In conclusion, our home-made ELISA, based on purified LPS of K. rhinoscleromatis showed high specificity and sensitivity in the diagnosis of antibodies to K. rhinoscleromatis in comparison to the complement fixation test. The presence of high level of specific IgA, IgG and IgM antibodies in the sera obtained in different stages of disease may showed that during the rhinoscleroma is permanent stimulation of antibody production.
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Anticuerpos Antibacterianos/análisis , Klebsiella pneumoniae/inmunología , Klebsiella pneumoniae/aislamiento & purificación , Rinoscleroma/diagnóstico , Rinoscleroma/microbiología , Animales , Ensayo de Inmunoadsorción Enzimática , Humanos , Inmunoglobulina A/análisis , Inmunoglobulina G/análisis , Lipopolisacáridos/inmunología , Conejos , Rinoscleroma/inmunología , Sensibilidad y EspecificidadRESUMEN
This paper was designed to study clinical manifestations of choanal atresia (CA) in 11 patients with a view to optimizing methods for medical and diagnostic management of this severe pathology using endonasal surgical techniques. Detailed analysis of possible causes of congenital CA and mechanisms of acquired CA was performed using computed tomography (CT) and retrograde endoscopy with the help of rigid optics. Potential of certain instruments designed and manufactured in Russia for the management of CA is demonstrated, such as retrograde 110o Sekunda endoscope and silicone horseshoe-shaped protectors. An original diagnostic algorithm is proposed allowing for the development of indications for surgical intervention, determination of its extent, and the choice of the post-operative treatment. Improved surgical instruments have been designed for the purpose. A case of hereditary CA in a child and his mother are presented along with results of treatment of nasopharyngeal scleroma in two patients. Clinical manifestations of CA concomitant with scleroma, diphtheria, and chemical chaonal burns are considered.
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Atresia de las Coanas , Endoscopía/instrumentación , Cavidad Nasal/cirugía , Rinoplastia/instrumentación , Adulto , Atresia de las Coanas/diagnóstico , Atresia de las Coanas/etiología , Atresia de las Coanas/fisiopatología , Atresia de las Coanas/cirugía , Endoscopía/métodos , Diseño de Equipo , Femenino , Humanos , Recién Nacido , Masculino , Cavidad Nasal/anomalías , Cavidad Nasal/diagnóstico por imagen , Cavidad Nasal/fisiopatología , Evaluación de Necesidades , Deformidades Adquiridas Nasales/diagnóstico , Deformidades Adquiridas Nasales/etiología , Deformidades Adquiridas Nasales/fisiopatología , Deformidades Adquiridas Nasales/cirugía , Rinoplastia/métodos , Rinoscleroma/complicaciones , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
To prospectively study a series of scleroma patients with a focus on socioeconomic status, clinical presentation, pathology, microbiology, and treatment. A total of 52 patients diagnosed with scleroma were included in the study. Demographic data of the patients were collected and clinical, radiographic, and histopathologic findings were analyzed. Biopsies from atypical patients were sent for electron microscopic examination. Patients were treated both medically and surgically with clinical follow-up to determine outcomes and the incidence of recurrence. Fifty-two patients were included in the study. There were 23 males (44.2%) and 29 females (55.8%). The highest incidence of scleroma was identified in individuals from poor, rural areas in the third to fourth decades of life. The nose was affected in all cases. Other affected sites included the nasopharynx, soft and hard palate, larynx and trachea, lacrimal passages, skin, and gingiva. Some patients had atypical presentations. Complete follow-up of all patients was hindered by non-compliance with clinic visits and the long duration of medical treatment. Recurrence or relapse of the granulomatous lesions after initial improvement occurred in 11 patients (21.2%) within 1 to 3 years. Scleroma is a stubborn, chronic, granulomatous bacterial disease. The diverse presentations may mimic neoplasms and other granulomatous conditions. We present cases with unusual presentations and demonstrate the transmission electron microscopic features of these lesions. Furthermore, we confirm the importance of achieving full eradication of the etiologic bacilli to prevent recurrent disease.
Asunto(s)
Rinoscleroma/epidemiología , Rinoscleroma/patología , Adolescente , Adulto , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Factores Socioeconómicos , Adulto JovenRESUMEN
OBJECTIVE: To find a fast and simple method for detection of specific pathogens in upper aerodigestive tract. METHODS: Sixty-one cases of specific infections in upper aerodigestive tract encountered during a 10-year period in Beijing Tongren Hospital were retrospectively studied. Six histochemical stains, including PAS, Giemsa, Gram, methylene blue, modified Warthin-Starry and acid-fast stains were applied. The morphology of different pathogens was studied and the staining patterns were compared. RESULTS: There were 23 cases of pharyngeal treponemal infection, 10 cases of short treponemal infection, 4 cases of mycobacterial infection, 4 cases of infection by rhinoscleroma bacilli, 1 case of sinonasal fungal infection, 1 case of combined infection of bacteria and Oidium albicans, 2 cases of tonsillar Actinomycetes and 16 cases of non-specific bacterial infections. Both pharyngeal treponemal infection and infection by rhinoscleroma bacilli could be detected by modified Warthin-Starry stain. As for sinonasal fungal infection, PAS, Giemsa and modified Warthin-Starry stains were useful in differentiating different types of fungi. Mycobacteria were best demonstrated by conventional acid-fast stain. CONCLUSIONS: Special histochemical stains performed on histologic sections are useful for diagnosing specific infections in upper aerodigestive tract.
Asunto(s)
Infecciones por Mycobacterium/patología , Enfermedades Faríngeas/patología , Faringe/patología , Infecciones por Treponema/patología , Actinomicosis/microbiología , Actinomicosis/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mycobacterium/aislamiento & purificación , Infecciones por Mycobacterium/microbiología , Tonsila Palatina/microbiología , Tonsila Palatina/patología , Enfermedades Faríngeas/microbiología , Faringe/microbiología , Estudios Retrospectivos , Rinoscleroma/microbiología , Rinoscleroma/patología , Coloración y Etiquetado , Treponema/aislamiento & purificación , Infecciones por Treponema/microbiología , Adulto JovenRESUMEN
The specific features of the pathological histology of scleroma have been continuously studied at the Pathology Department of the Lvov Medical University since 1945. A total of 1025 biopsy specimens from 656 patients with scleroma were examined. Along with diverse dystrophic and metaplastic changes in the epithelial coverings, which were affected by scleroma, there were its original inflammatory enlargements that were likely to play an active part in the inflammatory process. Abundant formation of fibrous structures in the granulation tissue undoubtedly reflects the protective functioning of an organism. Impaired innervation led not only to ageusia and anosmia in patients with scleroma; loss of nervous communications with the organism is very likely to affect the course of the pathological process to either degree. Electron microscopy provided more evidence for the presence of endobiosis in scleroma and the inability of drugs to affect directly the Frish bacillus due to its secreted mucopolysaccharide the composition of which is little studied.