Rhinoscleroma: Report of an Erratic Palatal Swelling

Abstract

Clinicians come across cases of palatal swellings that present with ambiguous features. They may vary in their etiology from numerous infectious and noninfectious causes to a wide array of neoplasms. Accurate diagnosis of such lesions is vital for their prompt and precise management. Rhinoscleroma (RS), as its name suggests, is a persistent, specific, granulomatous disease that results in sclerosis of the affected organ - most frequently the nose. Although its occurrence in the adjacent sites has been reported, the clinical findings did not offer much deviation from the expected. Reported here is a case of RS involving the palate which not only detoured from its usual site and course of spread but also gave off a confusing façade in terms of its clinical presentation.

Keywords: Chronic granulomatous inflammation; palatal swellings; rhinoscleroma.

Figure 1

Ovoid swelling involving right half of the palate

Figure 2

(a) Sagittal view showing isodense mass extending from the incisal alveolar process till the soft palate along with thinning of the palatal process. (b) Bilateral isodense mass involving the nasal cavity and right side of palate and erosion of palatal bone

Figure 3

(a) Scanner view shows dense fibrocellular connective tissue. (b) Russel bodies – Pale, homogenous, eosinophilic bodies representing excess immunoglobulin produced by the plasma cells (c) Chronic inflammatory cell infiltrate composed of plasma cells, lymphocytes, and foamy macrophages with centrally placed nucleus – Miculikz cells.

Figure 4

(a) Periodic acid–Schiff staining confirming the presence of pale pink rod-like bacilli. (b) Pale blue-stained microbes on Giemsa staining