Rhinoscleroma

Etiopathogenesis, Clinical features and Management

1. Rhinoscleroma

3. History

4. Rhinoscleroma
Progressive granulomatous disease
Commencing in the nose and later extending into
the nasopharynx and oropharynx, the larynx
and sometimes the trachea and bronchi.

5. Aetiology is multifactorial and usually seen in low
socio economic status and poor domestic hygiene
•Laryngeal involvement  designated as respiratory
scleroma, rather than rhinoscleroma
- Amoils and Shindo (1996) series of 22 pt with
rhinoscleroma. 13 had laryngeal involvement, of which 3
underwent tracheostomy

6. Etiopathology :
Caused by gram negative bacilli Klebsiella rhinoscleromatis /
Frisch bacilli / diplo bacillus.
F>M, any age
Difficult to isolate
Histology: Granulomatous tissue infiltrates in the
submucosa, characterized by the presence of plasma
cells, lymphocytes and eosinophils
Characteristic histological features= Mikulicz cells and
Russel body

7. Russel bodies
Miculicz cells

8. CLINICAL FEATURES
Three stages –
1.The atrophic stage
The features resemble that of atrophic rhinitis,
including crust formation and a foul smelling
discharge

9. 2. Granulomatous or proliferative (or nodular)
stage.
- Non-ulcerative nodules- bluish red and rubbery and
later become paler and indurated.
- These nodules never break down but fibrose and
decrease in size

11. Hebra Nose

12. 3.Cicatrizing stage:-
Adhesions and stenosis distort the normal anatomy
Extend to involve the lacrimal sac, maxillary sinus,
nasopharynx, hard palate, trachea and main bronchi
Bone involvement has also been reported
“Tapir’s nose”
Lymphatic spread is uncommon because of extensive
fibrous tissue deposition
Occasionally, malignant change

13. Complications :
1.External nose deformity
2.Vestibular stenosis
3.Cicatrization of soft palate
4.Nasal regurgitation
5.Tracheal stenosis

14. Diagnosis :
1. Culture on Mac Conkey’s agar
2. Levin test (complement fixation test) :
- High titres of antibodies against K. Rhinoscleromatis has been
demonstrated.
3. Microbiological examination and a confirmatory Biopsy

15. TreaTmenT :
- Usually self limiting course of its own accord
ending in the cicatrizing stage
- Bactericidal antibiotics in large doses for a
minimum of four to six weeks
Traditionally Used : streptomycin (1gm i.m)
and tetracycline (2 g/day) for 4-6wks

16. Recently used :
Oral rifampicin (450mg for a period of 6
weeks), sulphamethoxazole-trimethoprim
combination, and ciprofloxacin.
Local application of 2 % acriflavin for a
period of 8 weeks has been noted to be both
efficacious and nontoxic.
Intralesional steroids have been tried

17. Kailasa Regime :
-Carbolic acid (0.2ml) + Glacial acetic acid
(0.2ml) + Glycerine (0.4ml) + 10ml distilled
water is injected locally as 1 to 2 ml twice
weekly at multiple sites of the lesion.
-Usually 8-10 injections lead to complete
regression of granuloma and restoration of
normal nasal patency. This mixture causes
chemical necrosis of granuloma
-

18. Irradiation
- Total dose of 3000-3500 Gy over three weeks

19. References
1. Scott and Brown Otorhinolaryngology, Head
and Neck surgery 7
th
edition
2. Cummings Otolaryngology Head and Neck
Surgery, 5
th
edition
3. Diseases of ear, nose, throat. P.L. Dhingra 6
th

edition
4. Amoils CP, Shindo ML. Laryngotracheal
manifestations of rhinoscleroma. Ann Otol Rhinol
Laryngol. 1996;105:336-340.