This document describes a case study of a 12-year-old male patient presenting with a swelling over his nose and nasal obstruction for 2 months. On examination, the patient was found to have a bluish-red mass obscuring the nasal cavity. Biopsy results showed sheets of plasma cells, lymphocytes, and histiocytes consistent with rhinoscleroma. The patient was started on tetracycline treatment and recanalization of the nasal cavity was planned after 2 weeks. Rhinoscleroma is a rare granulomatous disease caused by Klebsiella rhinoscleromatis infection, characterized by nodular growths in the nasal mucosa.

1. Dr. Nikesh M Gosrani
ENT RESIDENT,
IGGMC, NAGPUR

2. HISTORY
 12 yr old male
 Of Makkatola,Chattisgadh
 c/o
swelling over nose- 2 months
Blocking/obstruction of nose-
2 months
• Increasing gradually

3. HISTORY
 Past history - not significant
 Family history - not significant
 Personal history - baths in lake/boring
well water

4. GENERAL EXAMINATION
 GC- mod
 Afebrile
 P-74/min
 BP- 120/80 mmHg
 No pallor/clubbing/cyanosis/icterus/edema
 Cervical lymphadenopathy

5. Systemic Examination
 Respiratory system -NAD
 Cardiovascular system - NAD
 Gastrointestinal system - NAD
 Central Nervous System - NAD

6. LOCAL EXAMINATION
Swelling over nose
extending from supratip to
dorsum, between nasolabial
fold horizontally.
Firm , woody on
consistency
Splaying of nasal bones
with telecanthus

7. LOCAL EXAMINATION
 Nose(A/R)
Bluish red mass
obscurring view of
both nasal cavity.
Sensitive to
touch, does not bleed
on touch, firm in
consistency.

8. LOCAL EXAMINATION
 Oral & oropharynx:
Ulcer over hard palate 0.5x0.5 cm
 IDL-WNL

9. INVESTIGATIONS
 Hematological investigations
-WNL
 CT scan
-
small mildly enhancing soft
tissue lesion in anterior part
of nasal cavity arising from
superior wall and blocking
the nares.

10. INVESTIGATIONS
PUNCH BIOPSY
Shows sheets of
plasma cells,
lymphocytes & few
foamy histiocytes
s/o rhinoscleroma

11. TREATMENT
 Presently on Tetracyclin 500 mg tds.
 Recanalisation is planned after two weeks of medical
treatment.

12. Discussion
 Granulomatous disease
 Klebsiella rhinoscleromatis, gram negative
encapsulated rod like bacillus
 Formation of nodules in mucosal& submucosal layer.
 No ulceration or suppuration.
 Mode of infection is unknown.
 4 stages: catarrhal stage
atrophic stage
nodular/ granulomatous stage
cicatrization

13. DISCUSSION
 Presence of an accumulation of plasma cells, lymphocytes &
eosinophils, Miculicz cells & Russel bodies found.
 High content of mucopolysacchrides around walls protects
organism
 Differential diagnosis: Atrohic rhinitis
Tuberculosis
Lupus vulgaris
 Diagnosis: clinical features
Compliment fixation test
Culture
Biopsy
Barylak ,s technique

14. DISCUSSION
 Modalities of treatment
-Antibiotics-Streptomycin
-Tetracycline
-Septran
-Chloramphenicol
-Local application – injection of mixture of carbolic
acid, glycerine &acetic acid
-steroid
-Removal of cicatrisation & recanalisation
- Radiotherapy

15. CONCLUSION
 Uncommmon in present decade
 Rhinoscleroma should be kept in mind.