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.
Pandharmise et al. (Wed,) studied this question.