Abstract
Objective: To educate clinicians on the presentation and management of this uncommon pathogen as it pertains to atrophic rhinitis and to review the role of autoimmune tendencies in the development of ozena in this patient with nasal infection by Klebsiella ozaenae.
Method: This case report describes a 17-year-old Somalian female with ozena (atrophic rhinitis). She presented to our tertiary care center in Kansas City, Missouri, in November 2011 with classic symptoms of atrophic rhinitis and was diagnosed based on a positive surgical culture of K ozanae. She was noted to have bilateral middle turbinate destruction preoperatively and has been treated thus far with serial surgical debridements, topical nasal rinses and an oral fluoroquinolone. We are measuring cure of her disease with multiple parameters including improved nasal obstruction (symptomatic), endoscopic documentation of resolution of rhinitis, and pathologic/microbiologic confirmation of cure.
Results: Our patient experienced temporary relief of her symptoms after endoscopic debridement. Recurrence of her symptoms was delayed by topical nasal rinses and steroids. A prolonged course of therapy with an oral fluoroquinolone augmented by serial nasal debridements was necessary to obtain resolution of her disease.
Conclusion: Management of atrophic rhinitis in the setting of K ozaenae infection is a multidisciplinary approach between surgical specialists and infectious disease specialists. Autoimmune factors may play a role in development and severity of this disease.
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