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Rhinoscleroma: eight Peruvian cases
Ciro Maguiña1, Juan Cortez-Escalante, Fernando Osores-Plenge
1Instituto de Medicina Tropical Alexander von Humboldt, Lima, Peru. cirom@upch.edu.pe
Abstract:
Rhinoscleroma is a rare infection in developed countries; although, it is reported with some frequency in poorer regions such as Central Africa, Central and South America, Eastern and Central Europe, Middle East, India and Indonesia. Nowadays, rhinoscleroma may be erroneously diagnosed as mucocutaneos leishmaniasis, leprosy, paracoccidioidomycosis, rhinosporidiasis, late syphilis, neoplasic diseases or other upper airway diseases. From 1996 to 2003, we diagnosed rhinoscleroma in eight patients attended in the Dermatologic and Transmitted Diseases service of "Cayetano Heredia" National Hospital, in Lima, Peru. The patients presented airway structural alterations producing nasopharyngeal, oropharyngeal and, in one patient, laryngeal stenosis. Biopsy samples revealed large vacuolated macrophages (Mikulicz cells) in all patients. Ciprofloxacin 500 mg bid for four to 12 weeks was used in seven patients and oxytetracycline 500 mg qid for six weeks in one patient. After follow-up for six to 12 months the patients did not show active infection or relapse, however, all of them presented some degree of upper airway stenosis. These cases are reported because of the difficulty diagnosing the disease and the success of antibiotic treatment.
Insights
Rhinoscleroma, a rare upper airway infection, can be misdiagnosed. Antibiotic treatment with ciprofloxacin or oxytetracycline showed success in Peruvian patients, though stenosis persisted.
Area of Science:
- Infectious Diseases
- Otolaryngology
- Dermatology
Background:
- Rhinoscleroma is a rare granulomatous bacterial infection caused by Klebsiella rhinoscleromatis.
- It predominantly affects the upper respiratory tract, particularly the nose and pharynx.
- Geographic distribution includes Central Africa, South America, Eastern Europe, the Middle East, India, and Indonesia, often misdiagnosed in endemic areas.
Purpose of the Study:
- To report cases of rhinoscleroma diagnosed and treated at a national hospital in Lima, Peru.
- To highlight diagnostic challenges and the efficacy of antibiotic therapy for rhinoscleroma.
- To document the long-term sequelae of upper airway stenosis following treatment.
Main Methods:
- Retrospective case series of eight patients diagnosed with rhinoscleroma between 1996 and 2003.
- Clinical presentation, diagnostic methods (biopsy with Mikulicz cells), and treatment regimens were reviewed.
- Patients received ciprofloxacin or oxytetracycline and were followed for 6-12 months.
Main Results:
- Eight patients presented with structural airway alterations leading to nasopharyngeal, oropharyngeal, and laryngeal stenosis.
- Biopsies confirmed rhinoscleroma by identifying characteristic Mikulicz cells (vacuolated macrophages).
- Antibiotic treatment (ciprofloxacin or oxytetracycline) resulted in no active infection or relapse, but all patients had residual upper airway stenosis.
Conclusions:
- Rhinoscleroma diagnosis can be challenging, often confused with other granulomatous diseases.
- Antibiotic therapy is effective in clearing the infection and preventing relapse.
- Upper airway stenosis is a significant long-term complication requiring management even after successful infection treatment.
