Rhinoscleroma Clinical Presentation

Updated: Apr 22, 2019
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Presentation

History

Rhinoscleroma is rare chronic granulomatous infection that should be considered in patients from countries in which the disease is endemic if they have nasal polyps that significantly adhere to the nasal septum with relative sparing of the sinuses. Most often, the presentation is nonspecific. Because of its mundane clinical presentation resembling chronic rhinitis, it often goes unrecognized. [14] Chronic nasal infection caused by K rhinoscleromatis is often a misdiagnosed infectious disease. [15] Chronic rhinitis, even in developed countries, should prompt its consideration, especially because specific diagnostic tools and effective treatments are available. Recurrent epistaxis may be evident. [12] Note the following possible history findings:

  • Nasal obstruction (most common complaint)

  • Rhinorrhea

  • Epistaxis

  • Dysphagia

  • Nasal deformity

  • Anesthesia of the soft palate

  • Difficulty breathing that progresses to stridor

  • Dysphonia

  • Anosmia

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Physical Examination

The initial nodule is often intra-nasal and small in size. [1] Rarely, if neglected, it can grow into an exophytic giant tumor, which may obstruct the entire respiratory tract. [16]  Rarely, rhinoscleroma of the nasal cavity may extrude into the oral cavity. [17] Rhinoscleroma may also extend into the orbit, to the base of the skull, and into the brain. [18] It may enter the brain through the cribriform plate.

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Complications

Rhinoscleroma is a rare cause of upper airway obstruction. Isolated tracheal obstruction. [19, 20] Subglottal stenosis may be a late sequela of rhinoscleroma. [21] Scleroma is known to cause slowly progressive asphyxia.

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