Upper airway obstruction due to rhinoscleroma: case report.
Rhinoscleroma is a very rare cause of upper airway obstruction with only isolated reports in the literature of rhinoscleroma with isolated tracheal obstruction. The course is usually chronic with the presentation most often being non-specific. We report a 54-year-old woman with progressive shortness of breath and wheezing over 7 years' duration. She was diagnosed and treated as bronchial asthma without improvement in her symptoms. At the time of referral to our institution, her flow-volume loop revealed fixed upper airway obstruction. Her chest radiography and other laboratory tests were normal. Bronchoscopy revealed a 70-80% irregular concentric stenosis of the trachea beginning immediately below the vocal cords and extending 4 cm distally. Biopsy showed characteristic Mikulicz histiocytes containing numerous gram-negative intracellular coccobacilli consistent with a diagnosis of rhinoscleroma. The patient was treated with laser resection of the stenosis followed by a course of ciprofloxcin and trimethoprim-sulfamethoxazole. She has remained asymptomatic over a year follow-up period and repeated biopsies have shown no evidence of recurrence.
Al Jahdali
H
H
Department of Medicine, King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia. jahdali@yahoo.com
Bamefleh
H
H
Memish
Z
Z
Al-Zuwayed
M
M
Al Othman
A
A
D000402:Airway Obstruction / Q000209:etiology* / Q000473:pathology; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001999:Bronchoscopy; D002939:Ciprofloxacin / Q000627:therapeutic use; D004417:Dyspnea / Q000209:etiology; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D053685:Laser Therapy; D008875:Middle Aged; D013902:Radiography, Thoracic; D012135:Respiratory Sounds / Q000209:etiology; D012226:Rhinoscleroma / Q000150:complications* / Q000175:diagnosis; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D000890:Anti-Infective Agents; D002939:Ciprofloxacin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination