In the hypertrophic stage of rhinoscleroma, both T1- and T2-weigh

In the hypertrophic stage of rhinoscleroma, both T1- and T2-weighted images show characteristic mild-to-marked high signal intensity.[6] Nasal endoscopy may reveal signs of all three stages of rhinoscleroma and aids accurate diagnosis based on histopathological

Depsipeptide in vitro examination and isolation of K rhinoscleromatis in culture.[7] A positive culture in MacConkey agar is diagnostic of rhinoscleroma, but it is positive in only 50 to 60% of patients. The diagnosis is confirmed by histology. Classic histopathologic findings include plasma cells and large vacuolated Mikulicz cells with clear cytoplasm that contains bacilli and Russell bodies (which are transformed plasma cells). Treatment of rhinoscleroma requires a combination of appropriate antibiotics and surgical debridement if there is significant airway obstruction. The results of current treatment are unsatisfactory and recurrence often occurs.[8] Moreover, no randomized controlled trials exist to compare various antibiotic treatment choices and their efficacy.[8, 9] De Pontual and colleagues in their retrospective series of 11

patients report a treatment duration of 3 to 9 months with ciprofloxacin (7 patients), ceftriaxone (2), tetracycline (2), and clofazimine (2). Relapses occurred in 3 of the 11 patients. They recommend fluoroquinolones as the first drug of choice, because of its good activity against Gram-negative bacilli, intracellular efficacy, and low toxicity profile.[10] Gaafar and colleagues in their

retrospective case series of 56 cases over 10 years report a medical treatment duration of 3 months with a combination of co-trimoxazole and rifampicin. Since 2003, this was replaced by ciprofloxacin for 3 months. Results were disappointing, as a high incidence of recurrence was found reaching acetylcholine up to 25% within 10 years.[8] Fawaz and colleagues in their study of 88 cases report a treatment duration of 4 to 20 weeks with rifampicin (63 patients), co-trimoxazole (11), and ciprofloxacin (14). Relapses occurred in 24 out of 88 patients (27%).[11] Recently, Suchanova and colleagues in their study of three cases suggest that management with long-term antibiotics (3–6 months) with the fewest side effects (ciprofloxacin and co-trimoxazole) plus or minus surgical debridement is the mainstay of therapy.[2] Zhong and colleagues in their retrospective case series of 40 patients over 30 years report that 27 patients remained relapse-free 1 to 10 years following treatment with antibiotics supplemented in some cases with surgery or radiotherapy.[12] Tan and colleagues in their study of four cases recommend a treatment regime consisting of a combination of ciprofloxacin and doxycycline for at least 6 months.[13] The cases of recurrences reported in the literature are not associated with any particular treatment regimen.

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