Abstract

Rhinoscleroma is a chronic granulomatous infectious disease first described by Ferdinand Ritter von Hebra in 1870. As the name denotes, this disease is characterized by the thickened tumefication of the nose and upper respiratory tract, which if left untreated can result in facial disfigurement. Extensive clinical presentation can mimic malignancies such as the nasal type extranodal NK/T-cell lymphoma, leading to overly aggressive treatment. Rhinoscleroma is endemic to the Middle East, Central Europe, South America, Africa, and South Asia. The disease rarely occurs in non-endemic regions and very few cases have been reported in the United States. We present a case of rhinoscleroma in a non-endemic setting of Berwyn, Illinois. The patient is a 35-year-old man with a history of intranasal drug use and a septoplasty about 5 years ago in Mexico who presented with a bulbous, firm nasal mass at the columella. The nasal mass did not resolve with first-line antibiotics and corticosteroid. Imaging revealed a 2.5 cm mass involving the anterior nasal cavity and maxilla with septal perforation posterior to the mass. A biopsy of the mass was performed and revealed squamous mucosa with abundant mixed inflammatory infiltrate and foamy macrophages with enlarged vacuoles. Gram stain highlighted gram negative bacilli within the vacuoles, consistent with the pathognomonic Mikulicz cells. The specimen was negative for acid fast stains, EBV, and leukocytic stains. Despite its rarity, the diagnosis of rhinoscleroma was made based on the classic histomorphological findings and thus ensured a measured treatment plan with appropriate antibiotics.