Rhinosclerosis A48.8

v.Hebra, 1870

Rare, chronic, bacterial (Klebsiella pneumoniae rhinoscleromatis - see Klebsiella below) infectious disease of the nose, oral mucosa and upper respiratory tract (Umphress B et al.).

Klebsiella pneumoniae subsp. rhinoscleromatis an immobile, encapsulated, Gram-negative rod. Transmission from person to person by droplet infection.

Rhinitic pre-stage with foetal nasal secretion, crusts, dry nasal and pharyngeal mucosa.

Later crusts and inflammatory hard infiltrates develop in the nasal mucosa, upper lip, pharynx and larynx.

Development of hard, reddish, painless, vegetative granulations with fusion to unshaped, nodular formations (Hebra- or tapir nose). The infectious granulomas can destroy adjacent bony structures. Undisturbed general condition.

Sprayscontaining glucocorticoids such as Nasonex, budesonide nasal spray(e.g. Pulmicort Topinasal) 1 spray in each nostril in the morning and evening. Moist compresses with antiseptic additives such as quinolinol (e.g. Chinosol 1:1000) or potassium permanganate (light pink) on externally accessible affected skin areas.

Antibiosis e.g. with Ciprofloxacin 250-500mg p.o. over 6-8 weeks.

Alternatively Tetracycline (e.g. Tetracycline 500 Wolff 2-4 times/day 1 Kps.) or Minocycline (e.g. Mino-Wolff) 2 times/day 100 mg p.o. over 6 months.

Alternatively: Cotrimoxazol p.o. (e.g. Eusaprim® forte 3 times/day 1 tbl.).

Alternative: Clofazimine (e.g. Lamprene) initial 50-100 mg/day p.o., maintenance therapy with 50 mg/day (under maintenance dose of 50 mg practically no NW).

1. Hebra F v (1870) About a strange new formation on the nose - rhinoscleroma. Vienna Med Weekly 20: 1-4
2. Kasper HU et al (2004) Rhinoscleroma associated with Rosai-Dorfman reaction of regional lymph nodes. Catholic Int 54: 101-104
3. Umphress B et al (2018) Rhinoscleroma. Arch Catholic Lab Med 142:1533-1536.