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Rhinoscleroma is a rare infection in developed countries; although, it is reported with some frequency in poorer regions such as Central Africa, Central and South America, Eastern and Central Europe, Middle East, India and Indonesia. Nowadays, rhinoscleroma may be erroneously diagnosed as mucocutaneos leishmaniasis, leprosy, paracoccidioidomycosis, rhinosporidiasis, late syphilis, neoplasic diseases or other upper airway diseases. From 1996 to 2003, we diagnosed rhinoscleroma in eight patients attended in the Dermatologic and Transmitted Diseases service of "Cayetano Heredia" National Hospital, in Lima, Peru. The patients presented airway structural alterations producing nasopharyngeal, oropharyngeal and, in one patient, laryngeal stenosis. Biopsy samples revealed large vacuolated macrophages (Mikulicz cells) in all patients. Ciprofloxacin 500 mg bid for four to 12 weeks was used in seven patients and oxytetracycline 500 mg qid for six weeks in one patient. After follow-up for six to 12 months the patients did not show active infection or relapse, however, all of them presented some degree of upper airway stenosis. These cases are reported because of the difficulty diagnosing the disease and the success of antibiotic treatment.O rinoscleroma é uma infecção rara nos países desenvolvidos, no entanto, tem sido relatado com alguma freqüência nas regiões pobres da África Central, América Central e do Sul, Europa Central e Oriental, Oriente Médio, Índia e Indonésia. A doença pode ser erroneamente diagnosticada como leishmaniose mucocutânea, hanseníase, paracoccidioidomicose, rinosporidiose, sífilis tardia, neoplasias ou outras doenças que afetam a via respiratória superior. No período de 1996 a 2003, foram diagnosticados oito casos de rinoscleroma no serviço de Doenças Dermatológicas e Infecciosas do Hospital Nacional "Cayetano Heredia", em Lima, Peru. Os pacientes apresentaram alterações estruturais das vias respiratórias, caracterizadas por estenose da nasofaringe e orofaringe, e em um paciente, a nível da laringe. As biópsias mostraram macrófagos com grandes vacúolos (células de Mikulicz). A ciprofloxacina 500 mg de 12/12 horas por quatro a 12 semanas foi usada em sete pacientes e oxitetraciclina 500 mg de 6/6 horas por seis semanas em um paciente. Durante o acompanhamento por seis a 12 meses todos os pacientes apresentaram cura clínica, sem recaída, embora exibissem algum grau de estenose na via respiratória superior. O motivo do relato deve-se ao fato desta doença constituir um grande desafio diagnóstico e pelo sucesso alcançado com o tratamento antibiótico.

Tuberculosis is a specific granulomatous infectious disease and a major cause of death in developing countries. Primary gingival tuberculosis is extremely rare and forgotten entity. Oral lesions usually appear as secondary to primary tuberculosis infection elsewhere. The lesion may take the form of nodules, ulcers, or elevated fissures. We report a case of primary tuberculosis of gingiva, manifesting as gingival enlargement with ulceration and discharge. Diagnosis was based on histopathologic examination, complete blood count, chest X-ray, and immunologic investigations with detection of antibodies against Mycobacterium tuberculosis. With the recent increase in the incidence of tuberculosis, this case report also emphasizes the need for clinicians to be aware of this possibility, consider tuberculosis in the differential diagnosis of gingival enlargement, and thus, play a role in the early detection of this disease.

Tuberculosis is a specific granulomatous infectious disease and a major cause of death in developing countries. Primary gingival tuberculosis is extremely rare and forgotten entity. Oral lesions usually appear as secondary to primary tuberculosis infection elsewhere. The lesion may take the form of nodules, ulcers, or elevated fissures. We report a case of primary tuberculosis of gingiva, manifesting as gingival enlargement with ulceration and discharge. Diagnosis was based on histopathologic examination, complete blood count, chest X-ray, and immunologic investigations with detection of antibodies against Mycobacterium tuberculosis. With the recent increase in the incidence of tuberculosis, this case report also emphasizes the need for clinicians to be aware of this possibility, consider tuberculosis in the differential diagnosis of gingival enlargement, and thus, play a role in the early detection of this disease. [ABSTRACT FROM AUTHOR]