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Rhinoscleroma Differential Diagnoses

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Jun 09, 2016
 
 

Diagnostic Considerations

Also consider the following:

  • Vasculitis
  • Neoplastic disease (eg, lymphoma)
  • Extranodal Rosai-Dorfman disease
  • Nasal polyposis [16]

Infectious granulomatous processes may include those caused by bacteria (tuberculosis, actinomycosis, syphilis, leprosy), fungi (histoplasmosis, blastomycosis, paracoccidioidomycosis, sporotrichosis), and parasites (mucocutaneous leishmaniasis).

Rhinoscleroma can mimic various inflammatory and neoplastic processes, including leprosy, paracoccidioidomycosis, sarcoidosis, basal cell carcinoma, and Wegener granulomatosis. Rhinoscleroma should be added to the list of opportunistic infections that can occur in patients infected with the human immunodeficiency virus.

Granulomatous lesions of the craniofacial area are common. These lesions vary in nature. They can be lymphohistiocytic with or without eosinophils; they can be tuberculoid with epithelioid cells and giant cells; or, occasionally, they are composed of essentially giant cells. The etiology of these lesions may be known or easy to discern. Their causes include foreign body granulomas, sarcoidosis, leprosy, rhinoscleroma, fungal diseases (especially zygomycosis and rhinosporidiosis[17] ), parasitic diseases, and cocaine-induced midline destructive erosions.[18]

Lethal midline granuloma is a clinical entity characterized by a necrotic and relentlessly progressive destructive presentation. After a malignant process (especially lymphoid) and Wegener granulomatosis are eliminated from the differentials, the diagnosis is idiopathic midline nonhealing granuloma. Some lesions remain in the facial area, whereas others disseminate as a malignant disease.

Central giant cell granuloma and histiocytosis X (especially eosinophilic granuloma) are 2 other varieties of granuloma that differ from the aforementioned granulomatous infiltrates in their clinical presentation and evolution.

Rhinoscleroma and Rosai-Dorfman disease can rarely coexist; both have a predilection for the respiratory tract and cervical lymph nodes, a protracted courses in younger individuals, biclonal plasma cell infiltrates, and distinctive histiocytes.[19] Distinction is important since therapy is different.

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Egle Goriniene, MD Staff Physician, Department of Infectious Diseases, New Jersey Medical School

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey P Callen, MD Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, American College of Rheumatology

Disclosure: Received income in an amount equal to or greater than $250 from: XOMA; Biogen/IDEC; Novartis; Janssen Biotech, Abbvie, CSL pharma<br/>Received honoraria from UpToDate for author/editor; Received honoraria from JAMA Dermatology for associate editor and intermittent author; Received royalty from Elsevier for book author/editor; Received dividends from trust accounts, but I do not control these accounts, and have directed our managers to divest pharmaceutical stocks as is fiscally prudent from Stock holdings in various trust accounts include some pharmaceutical companies and device makers for i inherited these trust accounts; for: Celgene; Pfizer; 3M; Johnson and Johnson; Merck; Abbott Laboratories; AbbVie; Procter and Gamble; Amgen.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Jacek C Szepietowski, MD, PhD Professor, Vice-Head, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University; Director of the Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Poland

Disclosure: Received consulting fee from Orfagen for consulting; Received consulting fee from Maruho for consulting; Received consulting fee from Astellas for consulting; Received consulting fee from Abbott for consulting; Received consulting fee from Leo Pharma for consulting; Received consulting fee from Biogenoma for consulting; Received honoraria from Janssen for speaking and teaching; Received honoraria from Medac for speaking and teaching; Received consulting fee from Dignity Sciences for consulting; .

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