Flesh Eating Bacteria: ENT Tropical Version

Since early February, I have been busy with a patient who has an unusual type of infection. The inside of his nose and left sinus is being eaten away slowly. He first showed up last month after he had such a bad nose bleed that he required transfusion of 15 units of blood. By the time I evaluated him, I could see the normal structures inside the left nose were gone. Over the course of the next couple of days, it was apparent he had some kind of infection slowly eating away from the inside out. It has taken some time to get a firm diagnosis, partially because of our limited lab support and partially because of my inexperience with a rare tropical disease. I am now fairly confident that he has a condition called rhinoscleroma which is caused by an unusual bacteria. For an American ear, nose, throat surgeon it is an obscure disease that is mentioned in one paragraph in our American ENT (Ear, Nose, Throat) textbooks. Something we were tested on, just to make sure we read the book. It is very rarely seen in the US, and then only in patients who have come from third world tropical climates. It can be treated with some common antibiotics and surgery, but not before significant damage has been done. He will need to be on antibiotics for six months, and even then the infection can recur. Today he went back for another surgery to remove dead bone and tissue from his nose and sinus. He now has a hole in the roof of his mouth. I am optimistic that we can control his disease now. If left untreated, it could eat away his cheek and nose and spread to other more vital structures in the head or airway.
This has been quite a trial for the patient who lives a three hour drive from here. He was going to be discharged at one point when he was looking better, but then by a miscommunication he did not take antibiotics for seven days. This is not uncommon when working with patients who do not speak English and who are unfamiliar with western medicine. He got much worse. He initially did not want to be admitted and treated again since he was already having a tough time paying his $500 dollar bill for 25 days in the hospital and three surgeries. We agreed to help him with our ENT Poor fund and he agreed to stay and undergo more surgery.
It is interesting that the Evangel Hospital ENT department is not new to the family of this patient. In 2005, his then two year old nephew’s life was saved by Dr. Joel Anthis, when Dr. Anthis removed a nail from the esophagus that had been present for many months. Many of our friends in the states have seen the chest x-ray image of the boy when we showed the Anthis video. Our ENT department is certainly well known to one family in Nigeria.

Michael Mitchell, MD