594. Imported Rhinoscleroma in Southern California
Session: Poster Session: Travel Medicine/Tropical Medicine
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Rhinoscleroma is a chronic, granulomatous disease of the upper respiratory tract, occurring mostly in tropical regions, associated with two subspecies of Klebsiella - K. rhinoscleromatis and K. ozonae. Classic histologic findings with this infection are granulomas with Mikulicz cells. In non-endemic areas, delays in diagnosis are common, resulting in increased morbidity from upper airway obstruction and deformity. We present 4 cases of rhinoscleroma diagnosed at a Southern California teaching hospital that serves immigrant populations.
Methods: Retrospective chart review of 11 patients referred between 1997-2008 for rhinoscleroma. Only 4 had the diagnosis confirmed by either respiratory tract culture and/or biopsy, and their cases are reviewed here.
Results: Median age of our patients was 28.5 years. All were immigrants from endemic areas (Mexico, Guatemala). All patients underwent nasal endoscopy and were noted to have both nasal and supraglottic involvement. One patient presented with subglottic stenosis requiring emergent tracheostomy. Most patients (3/4) presented with dysphonia and had involvement of the vocal cords. Duration of symptoms ranged from 3-14 years. All patients had sought medical attention previously and were misdiagnosed with allergic rhinitis. Nasal biopsies were obtained from all 4 patients - none had granulomas seen and only 1/4 had Mikulicz cells. However, all 4 nasal biopsies were culture positive for K. rhinoscleromatis (3/4) and K. ozonae (1/4). All patients received antibiotic therapy (quinolones or Bactrim) for 6-12 months. All had clinical improvement, however, one patient required a tracheostomy and 2 patients had persistent residual hoarseness. There were no known relapses during extended follow-up and no complications from antibiotic therapy.
Conclusions: Rhinoscleroma responds very well to prolonged antibiotic therapy, including quinolones. However, early diagnosis is essential to prevent long-term complications, as seen in some of our patients. Cultures should be obtained, as biopsies may be negative for typical pathologic findings. Given trends in immigration, we are likely to see more cases of rhinoscleroma in non-endemic areas.
Prashanti Alekal, MD1, Suzanne Donovan, MD2, Glenn Mathisen, MD2 and  P. Y. Alekal, None..
G. Mathisen, None..
S. Donovan, None., (1)West Los Angeles Veteran's Hospital, Los Angeles, CA, (2)UCLA-Olive View Medical Center, Sylmar, CA