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Primary Secondary Tertiary
Features:-Chancre Most infectious Gumma seen invading the
(Hard, non tender ulcerated papule) Symptoms – appear 6-10 mucous membrane periosteum
+ Rubbery nodes Wks after inoculation or bone
Sites :- External nose Most common Most common site
Or manifestation persistent Bony nasal septum
Inside the vestibule rhinitis +Crusts / fissure in Rarely
  the nasal vestibule Bony nasal wall
  Others:- Mucous patches in Frontal sinus
  the pharynx, roseolar or Floor of the nose
  papular rashes  
  Shotty enlargement of  
  lymph nodes  


Extra Edge. Saddling of the nose and palatal perforation is a feature of tertiary syphilis

  1. Congenital Syphils:-
    1. Early Form      
    2. ​Late Form
      1. Early : Congential Syphilis
        Presentation :- - 3rd week to 3rd month after birth
        - Manifests as simple catarrhal rhinitis - SNUFFLES
        - Secondary fissuring and excoriation of the nasal vestibule and upper lip
        - May interfere with sucking
      2. Late Form
        1. Occurs at puberty
        2. Shows gummatous and destructive lesions
        3. Other features (STIGMATA Of Syphilis)
          1. Hutchinson’s teeth
          2. Corneal opacities
          3. Sensorineural Deafness
          4. Interstitial keratitis
      3. Treatment:- Syphilis :- Benzathine penicillin : 2.4 I.M every week for 3weeks
  1. Tuberculosis
    1. ​Primary T.B. of the nose: very rare                               
    2. Usually secondary to pulmonary koch’s
    3. Site’s affected: Cartilaginous portion of the nasal septum and the anterior end of the inferior turbinate
    4. Confirmation: Biopsy
  1. Treatment: ATT
    1. Lupus Vulgaris:
    2. Definition: Lupus Vulgaris is an indolent and chronic form of tuberculosis infection
      Sites affected: Most common site is the mucocutaneous junction of the nasal septum. The nasal vestibule on the skin of the face.
    3. Features: The presence of apple-jelly nodules: skin lesions
    4. Treatment: Biopsy àATT
  1. Rhinoscleroma
    1. Definition: Chronic, progressive granulomatous disease commencing in the nose and eventually extending into the nasopharynx and oropharynx, larynx, trachea and bronchi.
    2. Organism: Klebsiella rhinoscleromatis (Gram negative: Frisch Bacillus)
    3. Features: Scleroma can occur at any age
      1. In either sex
      2. In India, Northern parts more affected
  1. Clinical Picture:
    1. Atrophic Stage:
      Atrophic changes occur in the floor of the nose, septum and turbinates
    2. Granulomatous Stage:
      1. Non-ulcerated painless bluish
      2. Red & rubbery nodules appear in the nasal mucosa
      3. Subdermal infiltration of the lower part of the external nose and the upper lip (woody feel)
    3. Cicatricial Stage:
      1. Adhesions & stenosis
      2. Coarsening of the external nose {Tapir Hose)
      3. The disease may extend to the maxillary sinus, lacrimal sac, nasopharynx, hard palate, trachea & mainbronchi
        P.S Malignant changes can occur
    4. Diagnosis:                                                                                            
      Submucosal infiltration of plasma cells, lymphocytes, eosinophils, Mikulicz cells & Russel bodies                  
      Mikulicz Cells:                                                                                                   
      Large foam cells with a central nucleus & vacuolated cytoplasm (contain the bacilli)   

MCQ. Rhinoscleroma is caused by a gram-negative coccobacillus-Klebsiella rhinoscleromatis. The disease passes through three stages-catarrhal, granulomatous and cicatricial. It causes woody infiltration of the upper lip. Other areas involved are larynx (subglottic region) and trachea leading to airway obstruction. Mikulicz’ cells and Russell bodies are characteristically seen on histology.

  1. Russell Bodies:           
    Eccentric nucleus and a pink- staining cytoplasm- Look like plasma cells.

MCQ. Russell bodies. Seen in rhinoscleroma. Plasma cells are seen to contain rounded eosinophilic structures on histopathology.


  1. Treatment:

  1. Leprosy
    The involvement of the nose as a part of systemic disease, more often in the lepromatous than tuberculoid or the dimorphous type.
    Site of involvement
    Anterior part of the nasal septum and the anterior end of the inferior turbinate.
    1. Features:
      1. Perforation of the nasal septum
      2. Atrophic rhinitis
      3. Depression of the nasal bridge
      4. Columellar retrusion
    2. Diagnosis. Scrapings from nasal mucosa or biopsy
    3. Treatment: Dapsone, Rifampicin, INH à reconstructive surgery

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