Tracheal rhinoscleroma: clinical, endoscopic, and radiological features in a five-patient case series and literature review

Abstract Background Rhinoscleroma is a chronic granulomatous infection caused by Klebsiella rhinoscleromatis , predominantly affecting the upper respiratory tract. Tracheal involvement is uncommon and may lead to progressive airway obstruction, delayed diagnosis, and severe respiratory complications. Methods We conducted a retrospective descriptive study of patients diagnosed with tracheal rhinoscleroma at the Department of Pulmonology of Hassan II University Hospital, Fez, between 2011 and January 2026. Clinical presentation, radiological findings, bronchoscopic characteristics, histopathological features, therapeutic management, and outcomes were analyzed. Results Five patients were included, comprising three women and two men, with a median age of 49 years (range: 10–50 years). Progressive dyspnea was present in all patients; while wheezing and inspiratory stridor were observed in selected cases. Subglottic involvement was the predominant localization. Bronchoscopic findings included circumferential inflammatory stenosis, pseudomembranous lesions, and complex subglottic narrowing. Computed tomography demonstrated tracheal wall thickening and luminal narrowing in most patients. Histopathological examination demonstrated chronic granulomatous inflammatory infiltrates compatible with rhinoscleroma. Three patients required interventional bronchoscopic management, including repeated bronchoscopic dilatations in one pediatric patient and emergency tracheostomy. All patients received prolonged ciprofloxacin therapy. Clinical outcome was favorable in most cases, although one patient developed ENT recurrence during follow-up. Conclusion Tracheal rhinoscleroma remains a rare but potentially severe cause of upper airway obstruction. Diagnosis is frequently delayed because of nonspecific clinical manifestations and its resemblance to other chronic airway diseases. Histopathological confirmation remains essential. Early recognition associated with prolonged antibiotic therapy and multidisciplinary airway management may improve prognosis and reduce irreversible airway stenosis.