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.
Endemic Diseases ; Fibrosis ; Human ; Klebsiella pneumoniae/*isolation & purification ; Korea ; Male ; Microscopy, Electron ; Middle Aged ; Nasal Mucosa/*microbiology/pathology/ultrastructure ; Rhinoscleroma/*pathology

OBJECTIVE: This paper aims to demonstrate the maxillary mucosa restoration after operation to the nasal fungal sinusitis. METHOD: Observation by microscopic, transmission electron microscopic and scanning electron microscopic was done to the same parts in the maxillary mucosa 3-4 months before and after the endoscopic sinus surgery in the 24 cases of the nasal fungal sinusitis during 2003-2005. RESULT: Before the operation, all the cases demonstrated epithelia shedding, proliferation, squamous metaplasia, glandular and fibrous tissue proliferation and lymphocytes infiltration. The microtubule was abnormal and mitochondria diminished, 3-4 months after operation, the cavity was clear and smooth and the epithelia complete. The cilia average increased and the cilia lined in the same direction. The structure of microtubules was clear. The mitochondria was elongated and dense. CONCLUSION There was no significant difference in the damage on ultramicrostructure of the maxillary mucosa between the chronic nasal sinusitis and chronic nasal fungal sinusitis. It is crucial in the successful recovery that the operation gives a thorough clean to the fungal clot and sinus aeration, and that good cleaning and sinus aeration are maintained after the operation. The ultramicrostructure restoration and the function recovery of mucosa will be achieved after careful cleaning for 3-4 months after operation.
Adolescent ; Adult ; Aged ; Chronic Disease ; Female ; Fungi ; Humans ; Male ; Microscopy, Electron, Scanning ; Microscopy, Electron, Transmission ; Middle Aged ; Mycoses ; pathology ; surgery ; Nasal Mucosa ; pathology ; surgery ; ultrastructure ; Sinusitis ; microbiology ; pathology ; surgery ; Young Adult