Successful Reconstruction of Rare Mutilating Exonasal Rhinoscleroma in an Elderly Patient: case report
A recent case report highlights the successful management of a rare, mutilating presentation of exonasal rhinoscleroma involving the lower nose and upper lip in an elderly patient. By integrating targeted antimicrobial therapy with rifampicin and topical acriflavine followed by complex reconstructive surgery, clinicians effectively restored the structural and aesthetic integrity of the nasal base and columella.
These findings of the case report are published in the Indian Journal of Otolaryngology and Head & Neck Surgery in July, 2025, by B. P. Belaldavar and team.
The significance of the report lies in its demonstration that advanced stages of rhinoscleroma can be successfully managed even when the disease causes substantial structural loss to the lower third of the face. It emphasizes that clinicians must maintain a high index of suspicion for such granulomatous conditions in tropical regions, particularly where low socioeconomic status and psychological stigma may prevent patients from seeking early medical intervention.
A geriatric patient presented with severe disfigurement of the lower nose and upper lip, which prompted a diagnostic biopsy that confirmed the underlying infection. To address the condition, the medical team initiated a treatment regimen of the antibiotic rifampicin and topical acriflavine to eradicate the pathogen, followed by successful reconstructive surgical procedures on the columella, nasal base, and nostrils that provided a favorable follow-up for the patient.
Mechanistic Insights
Pathologically, the disease typically advances through stages of inflammation and granuloma formation within the respiratory tract, yet this instance provides a unique look at the mechanistic progression into external facial tissues. The study provides insight into how the relentless progression of this infection can lead to a mutilated deformity of the lower nose and lip, necessitating a shift toward complex surgical restoration.
Potential Clinical Implementation
For healthcare practitioners, this case serves as a critical blueprint for the multidisciplinary treatment of neglected tropical diseases that have evolved into severe physical impairments. It contributes to the sparse Indian literature on successful reconstructive outcomes for rhinoscleroma, suggesting that patience and targeted surgical techniques can significantly improve the quality of life for affected patients despite the ruthless nature of the disease.
Reference
Belaldavar, B. P., Dhanraj, G. A., Bandyopadhyay, S., Havaldar, R. R., & Patil, P. H. (2025). A Solace for Ruthless Wrath of Exonasal Rhinoscleroma: A Case Report. Indian Journal of Otolaryngology and Head & Neck Surgery, 77, 5152–5156.
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