Dental and Medical Problems

Dent Med Probl
Index Copernicus (ICV 2020) – 128.41
MEiN – 70 pts
CiteScore (2021) – 2.0
JCI – 0.5
Average rejection rate (2021) – 81.35%
ISSN 1644-387X (print)
ISSN 2300-9020 (online)
Periodicity – quarterly

Download PDF

Dental and Medical Problems

2017, vol. 54, nr 4, October-December, p. 435–439

doi: 10.17219/dmp/76848

Publication type: clinical case

Language: English

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Creative Commons BY-NC-ND 3.0 Open Access

Difficulties in diagnosing and treating nasal rhinoscleroma: A case study

Trudności w diagnostyce i leczeniu twardzieli błony śluzowej nosa – opis przypadku

Paweł Poniatowski1,A,B,C,D,E,F, Klaudiusz Łuczak1,B,D,F, Kamil Nelke2,B,D,E,F

1 Department of Maxillo-Facial Surgery, Wroclaw Medical University, Poland

2 Department of Maxillo-Facial Surgery, 4th Military Hospital, Wrocław, Poland


For many years scleroma was considered to be a neoplastic tumor. First findings of this disease came from the 4th century. In the 18th century it was also called the leprosy of the nose. In 1840, a Polish surgeon was the first in the world to describe rhinoscleroma as a “chronic nose cancer”. In late 1877, Jan Mikulicz-Radecki classified this scleroma as rhinoscleroma, an inflammatory disease with the most common occurrence in the nasal cavity. Because of very rare cases of this disease reported nowadays (endemic), its treatment is challenging. The disease manifests itself as a symptomatic mass causing mostly an obstruction of nasal breathing or even local nose bleeds, and infiltrates the surrounding structures of the nose and sinuses. Difficult accurate clinical diagnosis of this disease seems to be the main problem in its early detection and treatment. Apart from a surgical excisional biopsy or more radical surgical approach, additional antibiotic treatment, along with routine checkups by an infectious diseases specialist, should be maintained. A very rare and unusual case of a 75-year-old retired otolaryngologist diagnosed with a symptomatic mass in the nasal cavity, treated previously by unknown methods and without any success, will be presented. It is worth noticing that either the patient’s economic status or his past job as an otolaryngologist might be related to the occurrence of rhinoscleroma as the possible route of infection.

Key words

rhinoscleroma, nasal cavity, diagnostic difficulties, treatment outcomes

Słowa kluczowe

twardziel błony śluzowej nosa, jama nosowa, trudności diagnostyczne,wyniki leczenia

References (22)

  1. Chan TV, Spiegel JH. Klebsiella rhinoscleromatis of the membranous nasal septum. J Laryngol Otol. 2007;21:998–1002.
  2. Simão I, Gaspar I, Faustino R, Brito MJ. Rhinoscleroma in a 5-year-old Portuguese Child. Pediatr Infect Dis J. 2014;33:774–775.
  3. Chou TC, Tsai KB, Lee CH. Emperipolesis is not pathognomonic for Rosai-Dorfman disease: Rhinoscleroma mimicking Rosai-Dorfman disease, a clinical series. J Am Acad Dermatol. 2013;69:1066–1067.
  4. Botelho-Nevers E, Gouriet F, Lepidi H, et al. Chronic nasal infection caused by Klebsiella rhinoscleromatis or Klebsiella ozaenae: Two forgotten infectious diseases. Int J Infect Dis. 2007;11:423–429.
  5. Allah KC, Kossoko H, Assi Djè Bi Djè V, Yéo S, Richard Kadio M. Giant rhinoscleroma. Rev Stomatol Chir Maxillofac Chir Orale. 2013;114:184–186.
  6. Ammar ME, Rosen A. Rhinoscleroma mimicking nasal polyposis. Ann Otol Rhinol Laryngol. 2001;110:290–292.
  7. Fuchs HA, Tanner SB. Granulomatous disorders of the nose and paranasal sinuses. Curr Opin Otolaryngol Head Neck Surg. 2009;17:23–27.
  8. Kulkarni MA, Mudholkar GV, Acharya SA, Ramteke VR. Histopathological study of lesions of nose and paranasal sinuses. Ind J Otolaryngol Head Neck Surg. 2012;64:275–279.
  9. Garg D, Mathur K. Clinico-pathological study of space occupying lesions of nasal cavity, paranasal sinuses and nasopharynx. J Clin Diag Res. 2014;8:4–7.
  10. Maru YK, Munjal S, Gupta Y. Brush cytology and its comparison with histopathological examination in cases of diseases of the nose. J Laryngol Otol. 1999; 113:983–987.
  11. Busch RF. Rhinoscleroma occurring with airway obstruction. Otolaryngol Head Neck Surg. 1993;109:933–936.
  12. de Pontual L, Ovetchkine P, Rodriguez D, et al. Rhinoscleroma: A French national retrospective study of epidemiological and clinical features. Clin Infect Dis. 2008;47:1396–1402.
  13. Fevre C, Almeida AS, Taront S, Pedron T, Huerre M, Prevost MC. A novel murine model of rhinoscleroma identifies Mikulicz cells, the disease signature, as IL-10 dependent derivatives of inflammatory monocytes. EMBO Mol Med. 2013;5:516–530.
  14. Ammar ME, Rosen A. Rhinoscleroma mimicking nasal polyposis. Ann Otol Rhinol Laryngol. 2001;110:290–292.
  15. Chan TV, Spiegel JH. Klebsiella rhinoscleromatis of the membranous nasal septum. J Laryngol Otol. 2007;121:998–1002.
  16. Gaafar HA, Gaafar AH, Nour YA. Rhinoscleroma: An updated experience through the last 10 years. Acta Otolaryngol. 2011;131:440–446.
  17. Abalkhail A, Satti MB, Uthman MA, Al Hilli F, Darwish A, Satir A. Rhinoscleroma: A clinicopathological study from the Gulf region. Singapore Med J. 2007;48:148–151.
  18. Zhong Q, Guo W, Chen X. Rhinoscleroma: A retrospective study of pathologic and clinical features. J Otolaryngol Head Neck Surg. 2011;40:167–174.
  19. Sood N, Sood S, Arora S. Cytohistological features of rhinoscleroma. Ind J Pathol Microbiol. 2011;54:806–808.
  20. Batsakis JG, el-Naggar AK. Rhinoscleroma and rhinosporidiosis. Ann Otol Rhinol Laryngol. 1992;101:879–882.
  21. Sun Y, Sun W, Lu X. Clinical analysis of 19 cases of scleroma respiratory treated surgically. Lin Chuang Er Bi Yan Hou Ke Za Zhi. 1998;12:314–316.
  22. Al Jahdali H, Bamefleh H, Memish Z, Al-Zuwayed M, Al Othman A. Upper airway obstruction due to rhinoscleroma: Case report. J. Chemother. 2001;13:69–72.