Rhinoscleroma

Monogrammisten N.N.
1645-1658
Artist from the Low Countries

♦ An old man with a growth on his nose ♦

This unidentified man with a growth on his nose is, judging by his outfit (a black skirt, greyish-yellow fur and a gousen medal), probably a nobleman.

♦ Diagnosis
Main symptoms: Large, flat and hard swelling of the nose.
Additional symptoms: An elderly man, richly dressed.
Clinical diagnosis: Rhinoscleroma

♦ Definition: rhinoscleroma
A new growth, almost as hard as stone, affects the nostrils and surrounding areas. The disease begins in the skin of the nasal vestibule and around the nostrils. The lesions consist of flat, isolated or fused nodules.

♦ Discussion
The diagnosis of rhinoscleroma for the nasal growth depicted in this painting in Stockholm was proposed in 1923 by E. Hollander in his book *Die Medizin in der Klassischen Malerei* (pp. 260–261).
Today, rhinoscleroma is endemic. The disease predominantly affects individuals living in disadvantaged rural regions of Central Europe, Africa, Indonesia, Egypt and Central America.
It is caused by Klebsiella rhonoscleromatis, a Gram-negative bacterium.
The Polish physician Johann von Mikulich described its histological characteristics in 1877; von Frisch identified the organism in 1932; and Belinov proposed the use of the term ‘scleroma respiratorium’, as the pathological process in rhinosclerosis affected not only the upper but also the lower respiratory tract. In 1961, Steffen and Smith demonstrated that Klebsiella rhinoscleromatis complied with Koch’s postulates and that it was an aetiological factor in the typical inflammatory manifestations of scleroma. In 1890, the German physician and bacteriologist Robert Koch had established the criteria for determining whether or not a particular bacterium was the cause of a given disease. Koch’s criteria brought much-needed scientific clarity to what had until then been a highly confusing area of medicine. He thus succeeded in proving the aetiology of anthrax and tuberculosis.
Koch’s postulates were as follows:
- the bacterium must be present in every case of the disease
- the bacterium must be isolated from the host of the disease and grown in a pure culture
- the specific disease must reappear when a pure culture of the bacterium is inoculated into a healthy, susceptible host
- it must be possible to recover the bacterium from the experimentally inoculated host

Source: Jan Dequeker

Rhinoscleroma

References