Quick Case: Rhinoscleroma Leads to Loss of Both Eyes in a 48-Year-Old Male

A 48-year-old male presented with proptosis and ethmoid sinus mass, epistaxis and bilateral nasal block for 4 years, in 2009. Lateral rhinostomy was performed, and the biopsy report came as granulomatous inflammation, possibly fungal infection. Within one year, the patient developed loss of vision in the left eye, due to severe proptosis, involvement of extraocular muscles and optic nerve damage. The left eye was removed, and the histopathology showed features of rhinoscleroma. In 2014, the patient returned with severe proptosis, epistaxis and bulging of frontal and ethmoidal sinuses, along with slow loss of vision in the right eye. MRI showed a fronto-nasal and right orbital huge nodular mass, possibly optic groove meningioma. Surgical exploration and removal of the masses/nodules, along with evisceration of the right eye were performed. Again, the diagnosis came as rhinoscleroma. The Mikulicz cells were plenty in number, and the organisms (Klebsiella rhinoscleromatis) were identified with PAS stained sections, shown in the imaging study photographs and photomicrographs.

samanta rhino 1

samanta rhino 2

Learning Points/Take Home Messages

Rhinoscleroma is better over-treated in the early stage to avoid disastrous complications!

About The Author

Dr-Swapan-Samanta-64x80
Dr. Samanta, MBBS, MD is currently a consultant at EKO Diagnostic PVT. LTD. Kolkata, India for histopath, cytopath and hematology. His other interests are: oncopathology, bone marrow and neuropathology.

 

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2 Comments

  1. Dr. Raghavendra D. Kulkarni
    Posted Apr 2015 at 8:12 am | Permalink

    Thanks for publishing on Rhinoscleroma.

    I had an opportunity to work on this condition long time ago. That was in the 1990s. We had done plenty of isolations of the organism. It is very easy to grow K. rhinoscleromatis. It produces typical big, watery colonies and is highly mucoid. The work was done at Govt. Medical College, Miraj. Most cases were from North Karnataka and we found that the cases responded adequately well to streptomycin.

    In the present era of high drug resistance an attempt to culture the organism and test the antibiotic sensitivity may be considered whenever possible.

    Congratulations to you for publishing on a rare infection.

  2. Dr. Swapan Samanta
    Posted Apr 2015 at 3:03 pm | Permalink

    Thanks for the comment!

    In fact, in our country most patients die so wrongly just because of the system…patients often do doctor-marketing and do not stick to one institution…

    In this case the patient visited at least 10 institution before I detected the actual disease only after evisceration! The surgeons are so overconfident that they still thinks this to be sarcoma or meningioma and the clinicians never thought of bacterial/tubercular culture…!

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