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Therapeutics in Dermatology
A reference textbook in dermatology
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Rhinoscléroma

5 October 2014, by ENJOLRAS O. & CARLOTTI A.

Rhinoscleroma is a chronic granulomatous infectious disease that most commonly affects the nasal cavity first. It is endemic in Africa, South East Asia, Central and Eastern Europe, Central and South America and Mexico. It is currently also observed outside these areas in Europe and North America among immigrants [4, 9]. It affects the nasal cavities in more than 96 percent of cases [9]. It then progresses to the neighbouring respiratory structures (oral cavity, pharynx, sinuses, larynx, Eustachian tube), the lower respiratory tract (trachea and bronchi) and even the orbits or the surrounding skin [1, 5, 6], hence the term “scleroma” sometimes preferred to that of “rhinoscleroma”. Rhinoscleroma can be divided into three stages: a catarrhal/atrophic stage, a hypertrophic granulomatous stage (stage where the diagnosis is easiest), and a late fibro-sclerotic stage [1]. It causes respiratory obstruction. It is caused by a Gram-negative bacterium, Klebsiella rhinoscleromatis. It seems boosted by low socio-economic conditions. Rhinoscleroma does not seem very contagious; it is thought to be transmitted through direct or indirect contact at the initial rhinitis stage. Diagnosis is based on the presence of a specific type of granulation tissue and by the presence of large foamy histiocytes (Mikulicz cells). Bacteriological confirmation is difficult to obtain in old lesions.

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