Rhinoscleroma – A unique masquerader. A retrospective case series

Abstract Objectives: Rhinoscleroma is a rare infectious disease of the upper respiratory tract caused by Klebsiella rhinoscleromatis. Apart from mandating an appropriate antibiotic therapy, it poses a unique challenge to the pathologists since it can clinically simulate a malignancy. The main objective was to study the cases of rhinoscleroma of the respiratory tract in a period of 3 years with an emphasis on the clinico-pathologic features. Methods: We report a retrospective analysis of 7 cases, histopathologically diagnosed at our centre as rhino-scleroma. The topography ranged from nasal mucosa (3), pharynx (2) and larynx (2). Results: Histopathological examination in all cases showed diffuse aggregates of foamy macrophages (Mikulicz cells) containing intracytoplasmic basophilic organisms; admixed with plasma cells in a fibrotic stroma. The overlying epithelium appeared atrophic to focally hyperplastic. The age ranged from 36–67 years, involving both genders. The significant clinical history included a nasal block without anosmia, atrophic rhinitis with septal perforation to subglottic stenosis, requiring immediate surgical intervention. In 4 of the 7 cases, the working clinical diagnosis was stipulated as a malignancy. Conclusions: Rhinoscleroma can affect different regions in the upper aero digestive tract. A lack of awareness and a delay in the diagnosis of this disease can lead to complications including upper airway obstruction, physical deformity, and rarely, sepsis. In addition, it must be remembered that the treatment of rhinoscleroma is challenging and requires a prolonged course of antibiotics to achieve a definite cure and avoid relapses.