Dr. Nikesh M Gosrani ENT RESIDENT, IGGMC, NAGPUR
HISTORY 12 yr old male Of Makkatola,Chattisgadh c/o swelling over nose- 2 months Blocking/obstruction of nose- 2 months• Increasing gradually
HISTORY Past history - not significant Family history - not significant Personal history - baths in lake/boring well water
GENERAL EXAMINATION GC- mod Afebrile P-74/min BP- 120/80 mmHg No pallor/clubbing/cyanosis/icterus/edema Cervical lymphadenopathy
Systemic Examination Respiratory system -NAD Cardiovascular system - NAD Gastrointestinal system - NAD Central Nervous System - NAD
LOCAL EXAMINATION Swelling over nose extending from supratip to dorsum, between nasolabial fold horizontally. Firm , woody on consistency Splaying of nasal bones with telecanthus
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.
LOCAL EXAMINATION Oral & oropharynx: Ulcer over hard palate 0.5x0.5 cm IDL-WNL
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.
INVESTIGATIONS PUNCH BIOPSY Shows sheets of plasma cells, lymphocytes & few foamy histiocytes s/o rhinoscleroma
TREATMENT Presently on Tetracyclin 500 mg tds. Recanalisation is planned after two weeks of medical treatment.
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
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
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
CONCLUSION Uncommmon in present decade Rhinoscleroma should be kept in mind.