May 24, 2023

EDUCATIONAL PEARL

Rhinoscleroma: Chronic infectious granulomatous disease of the paranasal sinus

• Presenting Symptoms: Nasal obstruction (polyps), rhinorrhea, anosmia, epistaxis, nasal deformity; may involve other portions of airway

• Epidemiology: Endemic to eastern Europe, East Africa, North Africa, Indian subcontinent, Latin America. Some suggest a genetic predisposition

• Etiology: Unclear; suggested risk factors include: EBV, tobacco use, autoimmune reaction, radiation

• Pathophysiology:

  1. Catarrhal: Persistent, purulent, foul-smelling rhinorrhea, nasal honey-colored crusting that last weeks

  2. Granulomatous: Non-tender granulomatous nasal masses (may also included lower airway such as glottis, subglottis); obstruction, epistaxis, destruction of septum, thickened soft palate

  3. Fibrotic: Lesions heal with extensive scar tissue formation (fibrotic narrowing of nasal passage)

• Histopathology: Mikulicz cell (foamy-histiocytes with intracellular inclusion bodies), Russell bodies, granulomas, and pseudoepitheliomatous hyperplasia

• Diagnosis: Biopsy, culture, serum antibodies

• Treatment: Long-term antibiotics determined by culture sensitivities (often tetracycline or fluoroquinolone), debridement, laser excision, bronchoscopy