Rhinoscleroma

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Rhinoscleroma

  1. 1. Dr. Nikesh M Gosrani ENT RESIDENT, IGGMC, NAGPUR
  2. 2. HISTORY 12 yr old male Of Makkatola,Chattisgadh c/o swelling over nose- 2 months Blocking/obstruction of nose- 2 months• Increasing gradually
  3. 3. HISTORY Past history - not significant Family history - not significant Personal history - baths in lake/boring well water
  4. 4. GENERAL EXAMINATION GC- mod Afebrile P-74/min BP- 120/80 mmHg No pallor/clubbing/cyanosis/icterus/edema Cervical lymphadenopathy
  5. 5. Systemic Examination Respiratory system -NAD Cardiovascular system - NAD Gastrointestinal system - NAD Central Nervous System - NAD
  6. 6. LOCAL EXAMINATION Swelling over nose extending from supratip to dorsum, between nasolabial fold horizontally. Firm , woody on consistency Splaying of nasal bones with telecanthus
  7. 7. LOCAL EXAMINATION Nose(A/R) Bluish red mass obscurring view of both nasal cavity. Sensitive to touch, does not bleed on touch, firm in consistency.
  8. 8. LOCAL EXAMINATION Oral & oropharynx: Ulcer over hard palate 0.5x0.5 cm IDL-WNL
  9. 9. INVESTIGATIONS Hematological investigations -WNL CT scan - small mildly enhancing soft tissue lesion in anterior part of nasal cavity arising from superior wall and blocking the nares.
  10. 10. INVESTIGATIONS PUNCH BIOPSY Shows sheets of plasma cells, lymphocytes & few foamy histiocytes s/o rhinoscleroma
  11. 11. TREATMENT Presently on Tetracyclin 500 mg tds. Recanalisation is planned after two weeks of medical treatment.
  12. 12. Discussion Granulomatous disease Klebsiella rhinoscleromatis, gram negative encapsulated rod like bacillus Formation of nodules in mucosal& submucosal layer. No ulceration or suppuration. Mode of infection is unknown. 4 stages: catarrhal stage atrophic stage nodular/ granulomatous stage cicatrization
  13. 13. DISCUSSION Presence of an accumulation of plasma cells, lymphocytes & eosinophils, Miculicz cells & Russel bodies found. High content of mucopolysacchrides around walls protects organism Differential diagnosis: Atrohic rhinitis Tuberculosis Lupus vulgaris Diagnosis: clinical features Compliment fixation test Culture Biopsy Barylak ,s technique
  14. 14. DISCUSSION Modalities of treatment -Antibiotics-Streptomycin -Tetracycline -Septran -Chloramphenicol -Local application – injection of mixture of carbolic acid, glycerine &acetic acid -steroid -Removal of cicatrisation & recanalisation - Radiotherapy
  15. 15. CONCLUSION Uncommmon in present decade Rhinoscleroma should be kept in mind.

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