*Corresponding author:
Daniel Xia Division of Hematopathology and Transfusion Medicine University Health Network 200 Elizabeth Street Toronto, Ontario M5G 2C4 Email: Daniel.xia@uhn.ca Phone: 416-340-4800 x4734
Consent information: Written informed consent was obtained from the patient to publish this report in accordance with the journal’s patient consent policy.
Abstract: Rhinoscleroma is a granulomatous infectious disease that typically affects the nasopharynx and upper respiratory tract. Non-endemic (e.g., North American) and laryngeal cases are rare. This case highlights the importance of pathognomonic Mikulicz cells for diagnosis.
A man in his early-50s presented with worsening stridor, shortness-of-breath, and hoarseness over 2 years. Originally from northwestern South America, he reported with similar symptoms 7 years ago, but work-up did not produce a specific diagnosis. For this presentation, a large obstructing mass on the laryngeal surface of the epiglottis was identified on emergency laryngoscopy that prevented visualization of the vocal cords and lower respiratory tract (Figure 1). Tracheostomy was performed. Biopsies showed squamous mucosa with submucosal fibrosis and a dense infiltrate, composed mostly of plasma cells and plasmacytoid lymphocytes, with rare/scattered macrophages containing intracellular gram-negative rods (Mikulicz cells; Figure 1) –suggesting a diagnosis of rhinoscleroma1,2.
Confirmatory cultures showed Klebsiella ozaenae . Subsequent ciprofloxacin led to improved stridor, near-complete regression of the supraglottic mass, with improved vocal cord mobility and patent subglottis; corking trials were carried out with the tracheostomy tube, and the patient was safely decannulated.  At 8-month follow-up, the laryngeal exam remains stable with no evidence of recurrence/regrowth.