eMedicine Specialties > Dermatology > Bacterial Infections

Rhinoscleroma: Follow-up

Author: Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Coauthor(s): Egle Goriniene, MD, Staff Physician, Department of Infectious Diseases, New Jersey Medical School
Contributor Information and Disclosures

Updated: Jul 2, 2009

Follow-up

Further Inpatient Care

  • Bronchoscopy plays a role in the follow-up care of patients.

Further Outpatient Care

  • Owing to the high rate of recurrence, prolonged antibiotic therapy (months to years) is necessary.
  • Nasal cytology is an easy and noninvasive investigation.
    • This method can be performed on an outpatient basis as an adjuvant to clinical and histopathologic studies, along with nasal endoscopy.
    • Nasal cytology is a simple, reliable, and timesaving procedure that can be used with further therapy.
  • Relapses occur, and close observation is the key to the long-term follow-up care of the patient.

Inpatient & Outpatient Medications

  • The choice of long-term antibiotic therapy should be guided by the patient's age and sex.
  • Repeat biopsy can be performed to help determine the appropriate duration of the antibiotic therapy.

Complications

  • Rhinoscleroma is a rare cause of upper airway obstruction. Only isolated studies in the literature report isolated tracheal obstruction.17,18
  • Scleroma is known to cause slowly progressive asphyxia.

Prognosis

  • The course is usually chronic.
  • Relapses can occur.
 


More on Rhinoscleroma

Overview: Rhinoscleroma
Differential Diagnoses & Workup: Rhinoscleroma
Treatment & Medication: Rhinoscleroma
Follow-up: Rhinoscleroma
References
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References

  1. de Pontual L, Ovetchkine P, Rodriguez D, et al. Rhinoscleroma: a French national retrospective study of epidemiological and clinical features. Clin Infect Dis. Dec 1 2008;47(11):1396-402. [Medline].

  2. De Champs C, Vellin JF, Diancourt L, et al. Laryngeal scleroma associated with Klebsiella pneumoniae subsp. ozaenae. J Clin Microbiol. Nov 2005;43(11):5811-3. [Medline].

  3. Sanchez-Marin LA, Bross-Soriano D, Arrieta J, et al. Association of HLA-DQA1*03011-DQB1*0301 haplotype with the development of respiratory scleroma. Otolaryngol Head Neck Surg. Mar 2007;136(3):481-3. [Medline].

  4. Abalkhail A, Satti MB, Uthman MA, Al Hilli F, Darwish A, Satir A. Rhinoscleroma: a clinicopathological study from the Gulf region. Singapore Med J. Feb 2007;48(2):148-51. [Medline].

  5. Azevedo-Bernarda R. Rhinoscleroma. Cent Afr J Med. Nov 1971;17(11):225-8. [Medline].

  6. Chan TV, Spiegel JH. Klebsiella rhinoscleromatis of the membranous nasal septum. J Laryngol Otol. Oct 2007;121(10):998-1002. [Medline].

  7. Salima K, Samia S, Mounir T, Fethi J, et al. [Rhinoscleroma: a report of 2 cases]. Tunis Med. Sep 2005;83(9):568-71. [Medline].

  8. 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. Sep 2007;11(5):423-9. [Medline].

  9. Ammar ME, Rosen A. Rhinoscleroma mimicking nasal polyposis. Ann Otol Rhinol Laryngol. Mar 2001;110(3):290-2. [Medline].

  10. Batsakis JG, el-Naggar AK. Rhinoscleroma and rhinosporidiosis. Ann Otol Rhinol Laryngol. Oct 1992;101(10):879-82. [Medline].

  11. Fuchs HA, Tanner SB. Granulomatous disorders of the nose and paranasal sinuses. Curr Opin Otolaryngol Head Neck Surg. Feb 2009;17(1):23-7. [Medline].

  12. Ingegnoli A, Corsi A, Verardo E, De Filippo M, Sverzellati N, Zompatori M. Uncommon causes of tracheobronchial stenosis and wall thickening: MDCT imaging. Radiol Med. Dec 2007;112(8):1132-41. [Medline].

  13. Maru YK, Munjal S, Gupta Y. Brush cytology and its comparison with histopathological examination in cases of diseases of the nose. J Laryngol Otol. Nov 1999;113(11):983-7. [Medline].

  14. Soni NK. Scleroma of the lower respiratory tract: a bronchoscopic study. J Laryngol Otol. Jun 1994;108(6):484-5. [Medline].

  15. Sun Y, Sun W, Lu X. [Clinical analysis of 19 cases of scleroma respiratorium treated surgically]. Lin Chuang Er Bi Yan Hou Ke Za Zhi. Jul 1998;12(7):314-6. [Medline].

  16. Divatia JV, Upadhye SM, Sareen R. Fibreoptic intubation in cicatricial membranes of the pharynx. Anaesthesia. Jun 1992;47(6):486-9. [Medline].

  17. Al Jahdali H, Bamefleh H, Memish Z, Al-Zuwayed M, Al Othman A. Upper airway obstruction due to rhinoscleroma: case report. J Chemother. Apr 2001;13 Suppl 1:69-72. [Medline].

  18. Busch RF. Rhinoscleroma occurring with airway obstruction. Otolaryngol Head Neck Surg. Nov 1993;109(5):933-6. [Medline].

  19. Claveau AM. [Scleroma and rhinoscleroma]. Med Trop (Mars). Jul-Sep 1992;52(3):291-7. [Medline].

  20. Cone LA, Barton SM, Woodard DR. Treatment of scleroma with ceforanide. Arch Otolaryngol Head Neck Surg. Apr 1987;113(4):374-6. [Medline].

  21. Escalera CL, Torres JS. [Rhinoscleroma (bibliographic review)]. ADM. Jul-Aug 1975;32(4):29-32. [Medline].

  22. Issing WJ, Bodlaj R. [Rhinoscleroma: a case report]. Laryngorhinootologie. Apr 1999;78(4):200-3. [Medline].

  23. Karchev T, Kabakchiev P. [Ultrastructural studies of Klebsiella rhinoscleromatis]. Vestn Otorinolaringol. Jan-Feb 1990;31-8. [Medline].

  24. Sedano HO, Carlos R, Koutlas IG. Respiratory scleroma: a clinicopathologic and ultrastructural study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Jun 1996;81(6):665-71. [Medline].

  25. Shum TK, Whitaker CW, Meyer PR. Clinical update on rhinoscleroma. Laryngoscope. Oct 1982;92(10 Pt 1):1149-53. [Medline].

  26. Yigla M, Ben-Izhak O, Oren I, Hashman N, Lejbkowicz F. Laryngotracheobronchial involvement in a patient with nonendemic rhinoscleroma. Chest. Jun 2000;117(6):1795-8. [Medline].

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Further Reading

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Keywords

rhinoscleroma, respiratory scleroma, scleroma, Mikulich disease, rhinosclerosis, Klebsiella rhinoscleromatis, K rhinoscleromatis, scleroma respiratorium, nasal polyposis, scleroma respiratorium

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Contributor Information and Disclosures

Author

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and 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.

Medical Editor

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: Stiefel Salary Employment; Orfagen Consulting fee Consulting; Maruho Consulting fee Consulting; Astellas Consulting fee Consulting

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey P Callen, MD, Professor of Medicine, 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, and American College of Rheumatology
Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Electrical Optical Sciences Honoraria Consulting; Centocor Honoraria Consulting; Medicis Honoraria Consulting; Celgene Honoraria Consulting

CME Editor

Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital
Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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