Rhinoscleroma Masquerading as a Nasal Mass: A Diagnostic Challenge in a Young Adult

Rhinoscleroma is a rare, chronic granulomatous disease of the upper respiratory tract caused by Klebsiella rhinoscleromatis. Although uncommon, it continues to persist in developing regions and often presents a diagnostic challenge due to its indolent course, nonspecific clinical features, and resemblance to other granulomatous or neoplastic conditions. We report the case of a 23-year-old male who presented with progressively worsening bilateral nasal obstruction, intermittent epistaxis, and persistent mucopurulent nasal discharge over a duration of six months. Endoscopic evaluation revealed multiple firm nodular lesions involving the nasal vestibule, septum, and extending to the hard palate, suggesting locally aggressive yet non-destructive pathology. Initial histopathological examination was inconclusive, demonstrating only nonspecific inflammatory changes. However, a repeat biopsy combined with immunohistochemical analysis confirmed the diagnosis. Radiological imaging showed a heterogeneously enhancing soft tissue lesion with smooth bony remodeling leading to near-total nasal obstruction, without evidence of bone destruction. The patient was managed with a combination of systemic corticosteroids and prolonged antimicrobial therapy, resulting in significant clinical improvement and regression of lesions. This case underscores the importance of maintaining a high index of suspicion in endemic areas, the diagnostic value of repeat biopsy, and the necessity of prolonged therapy to prevent recurrence and complications.