[8, 10] Because K rhinoscleromatis is an intracellular bacteria, prolonged courses of rifampicin and fluoroquinolones would theoretically be most effective, owing to their high concentration in macrophages.[14] On the basis of the physical and radiological examination, we adopted a conservative (non-surgical) approach prior to biopsy results; when the diagnosis of rhinoscleroma in granulomatous stage was made, surgical therapy was not considered, as there was no nasal or pharyngeal

obstruction.[6] In our patient, considering the extension of the lesion with invasion into the ethmoid sinuses and its potential extension to the central nervous system,[10, 15] he was given an aggressive antibiotic treatment with levofloxacin and co-trimoxazole Target Selective Inhibitor Library price for 12 months, plus rifampicin in the first 3 months. Moreover, in this case superinfection by S aureus was associated with rhinoscleroma; the antibiotics combination RG7204 solubility dmso he was given is extensively

used for staphylococcal infection.[16] In our case, the detailed MRI follow-up performed after 8 and 11 months had shown improvement based on both a decrease in the granuloma diameter and a reduction of enhancement. We suggest that the antibiotic treatment of rhinoscleroma in the granulomatous stage associated with a bony destruction should be continued for at least 6 months; in an economically developed country it should be maintained until repeated MRI scanning shows improvement. This report presents a case of nasal rhinoscleroma in granulomatous stage in an urban non-endemic

setting. Rhinoscleroma is extremely rare in Italy. Consequently, clinicians are infrequently confronted with this disease and the diagnosis may be missed. CT and MRI scans are useful in suggesting invasive space-occupying lesions with bony destruction of nasal turbinates. The diagnosis in this case was confirmed by histopathological findings TCL and by isolation of K rhinoscleromatis. Surgery was not considered in this patient as there was no nasal or pharyngeal obstruction; he was treated with intensive antibiotic therapy until detailed clinical and imaging follow-up showed benefits. The authors state they have no conflicts of interest to declare. “
“Rickettsial spotted fever is common in southeastern Brazil. Differential diagnosis of pathogens can be performed with proper laboratory methods. A traveler arriving from Portugal developed a fatal febrile hemorrhagic syndrome diagnosed as spotted fever rickettsiosis. We isolated the agent, which was identified as Rickettsia conorii conorii by sequencing rickettsial genes. Diseases caused by spotted-fever group Rickettsiae are important zoonosis and distributed worldwide. Rickettsiae are maintained in natural cycles involving several tick species, acting as their vectors and sometimes reservoirs, and vertebrate hosts present in a particular biotope.