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.

Learning Points/Take Home Messages

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