Cases reported "Rhinoscleroma"

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1/10. Laryngeal scleroma.

    Respiratory scleroma is a chronic, progressive granulomatous disease of the respiratory tract. The causal organism is the klebsiella rhinoscleromatis. The disease has three stages: the initial catarrhal stage, granulomatous stage, and sclerotic stage. The object of this report was to determine the clinical behaviour of the laryngeal scleroma. The study included 17 patients with this manifestation characterized by airway obstruction and dysphonia. The report revealed that respiratory scleroma affected the larynx in 40%, and the principal findings were glottic/subglottic stenosis.
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keywords = airway obstruction, airway, obstruction
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2/10. Laryngotracheobronchial involvement in a patient with nonendemic rhinoscleroma.

    We report the first case of rhinoscleroma in an Israeli citizen, a former sailor with a transatlantic shipping company. Characteristic histologic changes from a tracheal biopsy and isolation of klebsiella rhinoscleromatis from a blood culture after diagnostic bronchoscopy confirmed the diagnosis. Extreme delay in the diagnosis, a not uncommon feature in nonendemic areas, was associated with severe advanced laryngotracheobronchial disease. Treatment with quinolones was followed by significant improvement, but the patient died 1 month after presentation, apparently from upper airway obstruction.
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keywords = airway obstruction, airway, obstruction
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3/10. 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.
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ranking = 6.0345250950442
keywords = airway obstruction, airway, obstruction
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4/10. Nasal rhinoscleroma in a nonendemic area: a case report.

    rhinoscleroma is a chronic, granulomatous infectious lesion most frequently affecting the respiratory tract mucosa. This disease is endemic to africa, central and south america, South Central and Eastern europe, the middle east, and china. We report an extremely rare disease of nasal rhinoscleroma in korea. The patient was a 63-yr-old man, who suffered from chronic nasal obstruction and septal deviation. Characteristic histology from a nasal biopsy was proven and special stains for bacteria were employed: periodic acid-Schiff, Warthin-Starry silver, Giemsa, and Gram stains. Isolation of klebsiella rhinoscleromatis from a culture of nasal discharge was failed, but ultrastructural examination of numerous phagocyzed bacilli in the Mikulicz cells confirmed the diagnosis. The histiocytic nature of the Mikulicz cells was confirmed, using CD 68 and alpha-1 antitrypsin, and by the ultrastructural features of Mikulicz cells. Here, we emphasize the recognition of this rare entity in nonendemic regions, frequently leading to delayed diagnosis.
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ranking = 0.0345250950442
keywords = obstruction
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5/10. rhinoscleroma causing upper airway obstruction.

    rhinoscleroma is a chronic granulomatous condition of the respiratory tract, and is not uncommon in tropical regions; particularly, mexico, central america and the middle east. A few cases have been reported in north america, primarily involving immigrants from endemic countries. The causative organism is klebsiella rhinoscleromatis, a Gram-negative coccobacillus. Diagnosis is made on the basis of culture of the organism and the characteristic pathology of Mikulicz cells on light microscopy. The condition primarily affects the upper airway, and frequently presents with nasal discharge, nasal obstruction or frontal facial pain. Despite the term 'rhinoscleroma', there may be involvement of the entire respiratory tract. Although the condition is slowly progressive, its natural course portends extensive destruction. Laryngotracheal involvement occurs in approximately 15% to 80% of cases, but patients rarely present with isolated laryngotracheal disease. In the present paper, a case of rhinoscleroma presenting with symptoms of upper airway obstruction is described.
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ranking = 5.0692013947033
keywords = airway obstruction, airway, obstruction
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6/10. Fibreoptic intubation in cicatricial membranes of the pharynx.

    Two patients presented with almost total obliteration of the pharynx. In one, a membrane developed after corrosive poisoning; in the other, the oropharynx was filled with a dense cicatrix in the sclerosing phase of rhinoscleroma. In both patients, a single opening in the membrane provided access to both the larynx and oesophagus. Fibreoptic intubation allowed both a thorough assessment of the pathology and subsequently the passage of a cuffed tracheal tube to secure the airway. To overcome the problem of respiratory obstruction while the fibrescope passed through the opening in the membrane, either rapid intubation, or a technique using pre-oxygenation and voluntary hyperventilation followed by breath-holding during bronchoscopy, was used. The thin calibre and manoeuvrability of the flexible fibreoptic bronchoscope makes fibreoptic intubation an excellent technique of airway management in cicatricial membranes of the pharynx.
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ranking = 0.1038776943625
keywords = airway, obstruction
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7/10. An unusual case of laryngeal scleroma.

    An unusual case of nasal and laryngeal scleroma is presented. Laryngeal scleroma should be included in the differential diagnosis of obstructing lesions of the supraglottic airway. The immunoperoxidase staining method is useful in establishing the diagnosis in cases of equivocal culture and histopathologic appearance. It can further be used as an objective test to determine the effectiveness and duration of antibiotic therapy.
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ranking = 0.034676299659148
keywords = airway
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8/10. rhinoscleroma--a diagnostic challenge.

    rhinoscleroma is a rare chronic granulomatous infection predominantly affecting the upper respiratory tract. The patient presented here exemplifies several features of the disease, including the fact that diagnosis may elude the clinician for years, and this delay may increase morbidity substantially. The most common initial complaint is nasal obstruction, and physical examination frequently reveals erythematous granular or nodular swellings covered with crusts. Its tumor-like appearance and local spread arouses suspicion of malignancy, but differential diagnosis also includes fungal infections and numerous granulomatous diseases. The classic histopathology consists of large vacuolated Mikuliz's cells and transformed plasma cells with Russell bodies. Numerous antibiotics have been used for treatment of this infection with varying degrees of success. Long-term follow-up is important because these patients can have numerous relapses. Geographic distribution is also discussed.
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ranking = 0.0345250950442
keywords = obstruction
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9/10. rhinoscleroma: a growing concern in the united states? Mayo Clinic experience.

    rhinoscleroma is a chronic, progressive, granulomatous infection of the upper airways caused by the bacterium klebsiella rhinoscleromatis. Although most cases occur in developing countries, recent immigration patterns have led to an increasing number of patients with rhinoscleroma in the united states. rhinoscleroma may mimic various inflammatory and neoplastic processes, including leprosy, paracoccidioidomycosis, sarcoidosis, basal cell carcinoma, and Wegener's granulomatosis. Current therapy consists of a combination of surgical debridement and prolonged antimicrobial therapy. rhinoscleroma should be added to the list of opportunistic infections that can occur in patients with human immunodeficiency virus.
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ranking = 0.034676299659148
keywords = airway
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10/10. airway obstruction secondary to rhinoscleroma during pregnancy.

    dyspnea is a fairly common complaint during pregnancy. However, if one excludes allergic nasal congestion of pregnancy, upper airway obstruction is a distinctly uncommon cause of dyspnea in the pregnant patient. Three cases of laryngeal rhinoscleroma in pregnant women requiring tracheostomy for airway management are reported. All three delivered healthy infants vaginally. Postpartum, two of the three were successfully decannulated, while the third became pregnant again before decannulation was accomplished. Treatment options and a review of the literature are presented.
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ranking = 1.1727766798359
keywords = airway obstruction, airway, obstruction
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