Pediatric rhinoscleroma of the nasal cavity: A case report and review of literature

Abstract

Introduction and importance: Rhinoscleroma is a chronic granulomatous disease primarily caused by the bacterium Klebsiella rhinoscleromatis, affecting the upper respiratory tract and commonly found in regions with hot climates. While generally benign, its diagnosis can be complex due to diverse clinical presentations that often mimic other types of chronic rhinitis. This can result in severe deformities and stenosis if the condition is not recognized and treated promptly.

Case presentation: We report the case of a 10-year-old male patient, who consulted our ENT department for bilateral nasal obstruction. CT scan revealed a near-complete obstruction of the right nasal cavity by a tissue mass involving the inferior and middle turbinates, extending into the opposite nasal cavity. The pathological findings were consistent with Rhinoscleroma. The patient underwent surgical resection associated with medical treatment.

Clinical discussion: The disease progresses through four stages: catarrhal, crusty atrophic, proliferative, and sclerotic, characterized by nasal obstruction, anosmia, granulomatous tissue formation, and eventual stenosis. Diagnosis is confirmed through biopsy and bacteriological examination. Imaging studies, such as CT and MRI, help evaluate the extent of the disease. Treatment typically involves antibiotics like fluoroquinolones and streptomycin, while surgical intervention is reserved for advanced cases with significant functional impairment. Due to the intracellular nature of the bacteria, recurrence is common, necessitating prolonged treatment to prevent relapses.

Conclusion: Although rhinoscleroma is rare, its potential for misdiagnosis in the early stages can lead to delayed treatment and subsequent complications. Incorporating swab testing for Klebsiella rhinoscleromatis in cases of chronic nasal symptoms in endemic regions can enable early detection, facilitating timely intervention and improving patient outcomes.

Keywords: Case report; Klebsiella Rhinoscleromatis; Mikulicz cell; Nasal cavity; Pediatric; Pediatric rhinoscleroma; Rhinoscleroma.

Fig. 1

Image showing micro-uvula with enchased tonsils.

Fig. 2

Image showing the mass (blue star) that comes into contact with the lateral border of right nasal cavity (yellow star).

Fig. 3

CT scan showing a complete obstruction of the right nasal cavity (blue arrow) by the mass with an extension to the left nasal cavity (red arrow).

Fig. 4

Rhinoscopy of the left nasal cavity showing a free nasal cavity at three months post-op follow up.