鼻硬化しゅの一症例

Abstract

Rhinoscleroma is endemic in eastern Europe, North and Central Africa, and South and Central America. It is a rare disease in Japan. In 1917, Kuzume first reported a Japanese case of scleroma of the pharynx. Until 1982, only 3 Japanese cases had been reported. Rhinoscleroma is a chronic granulomatous infection predominantly affecting the upper respiratory tract. The patient presented here is a 41-year-old Japanese female. Her chief complaint is nasal deformity and nodular swelling of the nasal vestibule. Physical examination revealed: narrow nostrils, hard nasal wings, tumefaction of the left nostril, crusting of the nasal cavity, nodular swelling of the posterior wall of the naso- and mesopharynx, and scarring of the lateral wall of the pharynx. Laboratory findings were normal. The TB skin test was negative. A biopsy of the inferior turbinate showed a marked subepithelial infiltration with lymphocytes, plasma cells and macrophages. A PAS stain of the specimen showed large vacuolated histiocytes containing Klebsiella organisms (so-called Mikulicz cells). Klebsiella, Streptococcus agalactiae and Escherichia coli were recovered from the nasal secretion, and Klebsiella rhinoscleromatis was identified biochemically. The patient was treated with total doses of 20g of streptomycin and 8.4g of minocyclin and at the time of this writing is clinically free of disease.