Rhinoscleroma: Report of an erratic palatal swelling
Clinicians come across cases of palatal swellings that present with ambiguous features. They may vary in their etiology from numerous infectious and noninfectious causes to a wide array of neoplasms. Accurate diagnosis of such lesions is vital for their prompt and precise management. Rhinoscleroma (RS), as its name suggests, is a persistent, specific, granulomatous disease that results in sclerosis of the affected organ – most frequently the nose.

Published in the journal Contemporary Clinical Dentistry, the authors present a case of a 33-year-old male patient who reported with the chief complaint of a painless swelling involving right half of the palate for 5 years from the date of reporting.

The swelling initially appeared as a small mass in the central palatal region and then grew over time to involve the entire right half of the hard palate. The patient gave a history of being treated for RS which had manifested as a nasal swelling associated with chronic rhinitis 3 years back and reported a similar lesion at the same site 6 months back which was suggestive of recurrence.

Intraorally, the lesion presented as an ovoid swelling involving the right side extending from the palatal area corresponding to right canine up to approximately 1 cm beyond the third molar and transversely from the gingival margins of the teeth till midline of the palate.

The swelling was grossly 4 cm × 2 cm in size with regular, well-demarcated margins, and the overlying surface was smooth and of the same color as the adjacent palatal mucosa. On palpation, the swelling was nontender and soft to firm in consistency. Based on the history and clinical findings, a provisional diagnosis of palatal extension of RS was made.

Incisional biopsy of the lesion gave the impression of a chronic granulomatous inflammation. Scattered at places were several large macrophages (foamy histiocytes) having a central nucleus and vacuolated cytoplasm with rod-shaped bacilli at places resembling the Miculicz cells (MCs). Also evident were hyalinized plasma cells which were seen either discretely (Russell bodies) or in clusters (Mott cells).

The lesion was surgically excised and antibiotic therapy with tetracycline one gram twice a day along with Ciprofloxacin 500 mg/day for 1 month was started and continued as deemed fit by the physician. No recurrence has been observed up to the 6-month follow-up. The patient is kept under regular observation to monitor any incidence of recurrence.

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