Abstract
Rhinoscleroma is a chronic granulomatous bacterial infection caused by the gram-negative bacillus Klebsiella rhinoscleromatis. It predominately involves the nasal cavities but it can also involve the rest of the upper respiratory tract. Hypertrophic stage of rhinoscleroma may cause large tumor masses which could mimic neoplasm. Radiological imaging is essential for differentiation of rhinoscleroma from other granulomatous and malignant lesions. Imaging is also an important tool for detection of disease extensions and follow up post therapy. We illustrate the radiographic features of a patient with a giant rhinoscleroma using CT, MRI and CT virtual bronchoscopy for prompt diagnosis, assessment of disease extensions before therapy and follow up after therapy. The diagnosis was confirmed by tissue biopsy and culture. The patient received medical antibiotic treatment for 3 months after surgical excision of the lesion.
Highlights
Rhinoscleroma is a chronic granulomatous bacterial infection caused by the gram-negative bacillus Klebsiella rhinoscleromatis
The nasal polyps persisted to recur for 14 times for which he required surgical excision and antibiotic treatment each time
Physical examination revealed large nasal and palatal erythematous soft tissue masses which bleed on contact (Figure 1)
Summary
Inflammatory reaction mostly formed of lymphocytes, plasma cells with Russell bodies, together with foamy macrophages (Mikulicz’s cells) showing abundant clear vacuolated cytoplasm and intracytoplasmic bacilli (Figure 5). Treatment and follow up The patient had surgical excision of the nasal masses followed by antibiotic treatment in the form rifampicin treatment 150 mg twice daily for 4 months. Follow up CT scan following surgical excision and antibiotic treatment showed significant improvement with absent residual or recurrent nasal masses
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