trimethoprim--sulfamethoxazole-drug-combination and Rhinoscleroma

We have described a case of rhinopharyngeal rhinoscleroma, and reviewed the clinical behavior and management of this disease. Selective long-standing antibiotic treatment was successful in halting the process. Treatment of the advanced cicatrix with carbon-dioxide laser vaporization yielded excellent results.

Topics: Adult; Betamethasone; Cicatrix; Combined Modality Therapy; Drug Administration Schedule; Drug Combinations; Drug Therapy, Combination; Humans; Klebsiella pneumoniae; Laser Therapy; Male; Rhinoscleroma; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Ciprofloxacin; Female; Humans; Male; Rhinitis, Atrophic; Rhinoscleroma; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

Rhinoscleroma is a chronic granulomatous respiratory tract disease. The initial lesion site is often intra-nasal. Giant tumor presentations are rare. The authors report a case of extensive nasal rhinoscleroma.. A 35-year-old African male patient consulted for a large tumor of the nose. The tumor had appeared 25 years before; the initial lesion site was intra-nasal. It presented as a small non-obstructive growth. The tumor was removed 20 years before, and recurred in an exophytic presentation. The main tumor was associated to peripheral, peri-nasal, and upper lip nodules. There was a central granuloma, bleeding on contact. Nasal obstruction was complete. The histological and bacteriological examination of a biopsy specimen confirmed the diagnosis of rhinoscleroma. Trimethoprim-sulfamethoxazole was effective on the infection.. Rhinoscleroma is frequently located on the nasal mucosa, but extra-nasal giant tumor presentations are rare. It can involve the whole respiratory tract. It is endemic in developing countries. Sporadic cases have been described in non-endemic areas, among migrants. The diagnosis is proved by histology. Specific and early antibiotic therapy is effective. It avoids surgical mutilation, sequels, and recurrence.

Topics: Adult; Anti-Infective Agents; Disease Progression; Humans; Klebsiella Infections; Klebsiella pneumoniae; Male; Nasal Obstruction; Nose; Pefloxacin; Plastic Surgery Procedures; Rhinoscleroma; Trimethoprim, Sulfamethoxazole Drug Combination

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.

Topics: Airway Obstruction; Anti-Infective Agents; Bronchoscopy; Ciprofloxacin; Dyspnea; Female; Gram-Negative Bacterial Infections; Humans; Laser Therapy; Middle Aged; Radiography, Thoracic; Respiratory Sounds; Rhinoscleroma; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Airway Obstruction; Biopsy; Diagnosis, Differential; Hoarseness; Humans; Laryngoscopy; Male; Rhinoscleroma; Tracheostomy; Trimethoprim, Sulfamethoxazole Drug Combination

Two cases of rhinoscleroma in patients infected with the human immunodeficiency virus (HIV) who had stayed in an area of endemic Klebsiella rhinoscleromatis are reported. One of the patients presented with oropharyngeal lesions, an unusual clinical picture. Both patients suffered from a major cellular immune deficiency. The importance of Klebsiella rhinoscleromatis infection in AIDS-related oropharyngeal pathology and the possible treatment of such infection in HIV-positive patients are not yet clearly established.

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Follow-Up Studies; Humans; Klebsiella; Male; Oropharynx; Rhinoscleroma; Trimethoprim, Sulfamethoxazole Drug Combination