Skin affection in rhinoscleroma. A clinical, histological and electron microscopic study on four patients

Clinical, histological and electron microscopic studies were performed on 4 rhinoscleroma patients with concomitant skin lesions in the upper lip, dorsum of the nose and nasolacrymal sac area. The skin lesions were treated locally. One of the patients was followed up to 16 years. Histologically, the skin lesions showed downward prolongation of the rete pegs. Deep in the dermis, vacuolated Mikulicz cells surrounded by lymphocytes and plasma cells were found. By electron microscopy, numerous small vacuoles containing fine granular material were seen inside Mikulicz cells. A limited number of bacilli were found inside and outside these cells. Two clinical entities of rhinoscleroma are observed in Egypt, an active granulomatous type with possible extranasal extension, and a less active intranasal type with limited mucosal lesions. The skin lesions in rhinoscleroma were found to have an unpredictable course.