Images of Memorable Cases: Case 54 This 14-year-old girl from El Salvador presented with a one-year history of throat discomfort and nasal stuffiness. 54. Rhinoscleroma A chronic, progressive infection of the upper airways caused by Klebsiella rhinoscleromatis. Biopsies of the cobblestone-like masses in her oropharynx and nasal passages showed granulomatous inflammation; culture of the specimens grew the causative organism. Treatment requires surgical debridement and prolonged antibiotic therapy. Most cases occur in developing countries, but because of recent immigration patterns, the incidence of this disease in the United States is increasing.