Rhinoscleroma with Involvement of the Maxillary Sinus

Rhinoscleroma is a chronic granulomatous infection of the upper respiratory tract, particularly affecting the nose. It is a bacterial disease mainly caused by rhinoscleromatis subspecies of Klebsiella pneumoniae. We described a case of a 72-year-old Chinese man presented with repeated epistaxis for more than 2 years without any inducing factors accompanied by nasal obstruction, purulent discharge, nasal itching irritation of the left facial skin for 9 months and right ear for 3 months. Computer tomography showed a mucosal thickening in the nasopharynx, a shrinking of the nasal cavity structure, and a maxillary sinus inflammation. MRI showed a superficial thickening of the nasopharyngeal mucosa, a disappearance of the bilateral pharyngeal orifice of the Eustachian tube, and a flake high signal in the nasal cavity and maxillary sinus. A histopathology report showed a mixed inflammatory cell infiltrate and a collection of large, foamy Russell bodies and vacuolated Mikulicz cells beneath the nasal squamous epithelium. Rhinoscleroma is a quite rare case in the Otorhinolaryngology department but it is important to consider the etiology, diagnosis, and treatment of the disease. Rhinoscleroma requires a prompt diagnosis and treatment which may be fatal if the treatment is delayed. We managed our patient conservatively using intramuscular streptomycin and hemostatic anti-inflammatory drugs.