Kallel Souha, Ghorbel Abdel Mounem
Service ORL et Chirurgie Cervico-Faciale, CHU Habib Bourguiba, 3029 Sfax, Tunisie.
Pan Afr Med J. 2018 Dec 26;31:247. doi: 10.11604/pamj.2018.31.247.14104. eCollection 2018.
We report the case of a 80-year old hypertensive female patient, presenting with bilateral nasal obstruction not improved by symptomatic treatment. The examination of the nasal cavity showed pseudotumoral hypervascularized granulomatous bleeding lesion on both sides of the anterior portion of the nasal septum (A). The remainder of the septal mucosa showed granulomatous appearance. CT scan of the facial bones showed tissue lesion of the nasal cavities on both sides of the septum which was moderately enhancing after injection of iodinated contrast medium (ICM), without bone lysis (B). Biopsy showed rhinoscleroma. The patient received combination therapy including cyclin associated with cotrimoxazole without disappearance of the nasal lesion. Endonasal excision of the septal mass was performed. Histological examination confirmed the diagnosis of rhinoscleroma. The patient underwent ciprofloxacin therapy for 1 month. Patient evolution was good with nasal clearance at 1-year follow up. Rhinoscleroma is a granulomatous infection of the nasal cavities due to enteric bacterium belonging to the Klebsiella family (Klebsiella rhinoscleromatis). Treatment is essentially medical. Surgery is used to remove obstructive pseudotumoral lesions resistant to medical treatment.
我们报告一例80岁的高血压女性患者，表现为双侧鼻塞，对症治疗无效。鼻腔检查显示鼻中隔前部两侧有假肿瘤样血管增生性肉芽肿性出血病变（A）。鼻中隔其余黏膜呈肉芽肿样外观。面部骨骼CT扫描显示鼻中隔两侧鼻腔组织病变，注射碘化造影剂（ICM）后呈中度强化，无骨质溶解（B）。活检显示为鼻硬结病。患者接受了环磷酰胺联合复方新诺明的治疗，但鼻腔病变未消失。遂行鼻中隔肿物鼻内切除术。组织学检查确诊为鼻硬结病。患者接受了1个月的环丙沙星治疗。1年随访时患者病情好转，鼻腔通畅。鼻硬结病是一种由克雷伯菌属（鼻硬结克雷伯菌）肠道细菌引起的鼻腔肉芽肿性感染。治疗主要是药物治疗。手术用于切除对药物治疗耐药的阻塞性假肿瘤样病变。
