Rhinoscleroma is a chronic indolent granulomatous infection of the nose and the upper respiratory tract. The average time of presentation between the onset and diagnosis is about a decade. An unusual case of Rhinoscleroma in a young immune-competent male with a two month history mimicking as invasive fungal sinusitis is being presented. While Radiological appearance is not pathognomonic of rhinoscleroma, nasal endoscopy is both diagnostic and therapeutic. Histopathology report is confirmatory for rhinoscleroma. Introduction Rhinoscleroma (RS) is caused by Klebsiella rhinoscleromatis, which is a gram negative encapsulated diplobacillus. It is a chronic, specific granulomatous disease that manifests an affinity for the mucosa of the upper respiratory tract. Poor hygiene, crowded living environment and mal-nutrition appear necessary for infection and transmission[1]. It is most frequently recognized in young adults, who may have symptoms for over 10 years prior to diagnosis.[2] We present an unusual case of rhinoscleroma in a young HIV negative male, who presented with a short history of two months and was treated as acute sinusitis. Computed tomography was suggestive of invasive fungal pan-sinusitis with breach of the medial wall of the left orbit. Biopsy confirmed the diagnosis of Rhinoscleroma. Case Report A 25-year-old male patient presented with a history of nasal discharge and nasal blockage more on the left side associated with headache and low grade fever for two months. He was diagnosed and treated as a case of acute sinusitis with some relief. Patient had a recurrence of symptoms after he discontinued the antibiotics and consulted us on developing pain in the left eye. General physical examination was normal. Otorhinolaryngological examination revealed DNS to left and thick nasal discharge on both sides. No nasal mass was seen. A Computer Tomography (CT) scan PNS revealed hyper-dense soft tissue masses with surrounding hypo-densities in bilateral maxillary, ethmoid, sphenoid and frontal sinuses with destruction of ethmoid septa, thinning of turbinates and destruction of medial wall of the left orbit. (Fig1, Fig 2). A diagnosis of invasive fungal sinusitis with orbital extension was made and patient was taken for surgery.
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