Rhinoscleroma Differential Diagnoses

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

Diagnostic Considerations

Also consider the following:

  • Vasculitis
  • Neoplastic disease (eg, lymphoma)
  • Extranodal Rosai-Dorfman disease
  • Nasal polyposis [22]
  • Atrophic rhinitis [23]

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 [24] ), parasitic diseases, and cocaine-induced midline destructive erosions. [25]

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. [26] Distinction is important since therapy is different.

Differential Diagnoses