Cacho BE, Hernández DAE, Pérez ACR, Uribe QMF, Roque MMF

Language: Spanish
References: 6
Page: 24-29
PDF size: 290.52 Kb.

ABSTRACT

Background: Rhinoscleroma is a chronic granulomatous disease that commonly involves the upper respiratory tract, mainly the nasopharynx. The gramnegative bacillus involved is Klebsiella rhinoscleromatis and it mainly affects women. The clinical presentation is divided into three stages: catarrhal, proliferative or granulomatous, and sclerotic.
Clinical case: A 9-year-old male patient, who showed an unusual presentation of nasal rhinoscleroma, with symptoms of bilateral nasal obstruction, recurrent epistaxis, hyposmia, and headache. The physical examination showed a sinonasal tumor and a contrasted CT was performed, finding bilateral sinonasal occupation and bone erosion, a biopsy was taken without a definitive diagnosis. It was decided to perform a combined endoscopic and bilateral Caldwell-Luc approach, obtaining histopathological results of rhinoscleroma in proliferative and scarring phase. Antibiotic treatment was started with ciprofloxacin 250 mg every 12 hours per 6 months. Three months after surgery, a gadolinium-enhanced magnetic resonance evidenced again bilateral sinonasal occupation, for which an endoscopic biopsy was performed, finding turbinoseptal synechiae, abundant fibrous tissue, septal perforation, and a cobblestone-like mucosa. The histopathological study reported rhinoscleroma again.
Conclusions: In tumor conditions of the airways, it is important to consider respiratory scleroma as part of the differential diagnosis, a chronic process that requires clinical, histopathological confirmation and imaging support.

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