Nasal Rhinosporidiosis Research Articles

A rare case of disseminated cutaneous rhinosporidiosis.

A 22-year-old male student came to the surgery department of a tertiary care hospital in South, Tamil Nadu (India) with complaint of recurrent multiple subcutaneous swellings, presenting as tumour like nodules, biggest over the anterior abdominal wall measuring 12 cm in diameter [Table/Fig-1,​,2].2]. The nodules were big, disfiguring and some of them showed ulceration. Clinically the patient was symptom free. Blood investigations done showed no signs of immune suppression. Internal organs were free of any lesion in CT. He had past history of surgery for nasal mass seven years back. He developed all these masses since 10 y. He also developed mental depression due to disfiguring masses and had been on antidepressant therapy for the same. The biggest mass in the anterior abdominal wall was surgically excised. [Table/Fig-1]: Multiple disfiguring tumour like nodules over the body [Table/Fig-2]: Multiple disfiguring tumour like nodules over face Gross examination of the excised mass from abdomen wall [Table/Fig-3] showed a nodular, firm, solid, whitish mass measuring 12 x 12 x 6 cm just below the skin. [Table/Fig-3]: Gross appearance of the excised abdominal mass Histopathological examination of the sections showed hyperplastic stratified squamous epithelium with underlying subcutis enclosing many well-defined thick walled sporangia of varying shapes. The sporangia were in various stages of development and showed many endospores inside [Table/Fig-4–7]. Immature and collapsed sporangia were also present. [Table/Fig-4,5]: Microscopic appearance (H&E 5X) showing skin overlying large sporangia with numerous endospores in different stages of development [Table/Fig-6,7]: High power view (H&E 20X and 40X)showing skin with underlying thick walled sporangia containing spores Rhinosporiodosis is a chronic granulomatous disease [1]. The causative organism was first reported by Malbran but later described by Guellermo Seeber and hence its name, Rhinosporidium seeberi. Few authors have suggested cyanobacterium Microcystis aeruginosa as the causative agent [2] for rhinosporidiosis. It is more commonly seen in men than in women [3,4]. Bathing in water bodies like lakes filled with stagnant water in areas endemic for Rhinosporidiosis has been considered as a major risk factor [5] because Rhinosporidium seeberi is an aquatic parasite [6]. In India, the disease is reported to have higher prevalence in West Bengal and Tamil Nadu [7,8]. Rhinosporidiosis can manifest in various forms as nasal, ocular, mucosal, cutaneous or disseminated (rare) [9]. Dissemination to anatomically unrelated sites is mainly attributed to haematogenous spread [5]. Disseminated cutaneous lesions are very rare [10–12] and are generally associated with mucosal lesions [9]. About 20 cases of disseminated cutaneous rhinosporidiosis have been reported in the literature till date [4]. Ours is one such case. Cutaneous rhinosporidiosis present as warty papules or nodules with whitish spots, crusting, and bleeding on the surface. Careful inspection of the surface of warty lesions and concurrent or previous history of nasopharyngeal lesions usually help in the diagnosis of cutaneous rhinosporidiosis. Three types of skin lesions can occur: [9] Satellite lesions, in the skin adjacent to the nasal Rhinosporidiosis; Generalized cutaneous type with or without nasal involvement, occurring through hematogenous dissemination of the organism; Primary cutaneous type associated with direct inoculation of organisms on to the skin [13]. Our case belong to generalised Cutaneous type of Rhinosporidiosis. The various clinical differential diagnoses include warts, verrucous tuberculosis and granuloma pyogenicum [9]. Microscopically it has to be differentiated from Coccidiomycosis which would show spores of smaller size (less than 60 mu in diameter). R seeberi cannot be isolated in synthetic media,but it grows well in cell culture. Recent studies have shown the importance of performing aspiration cytology in such cases for early diagnosis [4,5]. The diagnosis can also easily be clinched by performing a Giemsa-stained imprint smear [9]. However, histopathology is essential for a definitive diagnosis of Rhinosporidiosis [4]. The treatment for rhinosporidosis consists of surgical excision followed by cauterization of the base. Medical therapy with Dapsone has proved beneficial. Our patient, who had a pharyngeal lesion, which was surgically excised came with recurrent multiple disseminated cutaneous lesions. Development of a cutaneous lesion may be an indication of early dissemination and thorough search should be made to exclude systemic involvement. However, our patient did not reveal any systemic lesions. Our case was treated with excision diathermy and dapsone therapy, despite the fact that it is quite ineffective. This case is presented for its rarity and also to highlight its presentation as Cutaneous and pharyngeal lesions.

Disseminated Rhinosporidiosis with Cutaneous Involvement

Rhinosporidiosis is a fungal infection that commonly involves the nasopharynx. Involvement of the skin is uncommon. We report a case of disseminated cutaneous rhinosporidiosis in a 56 year old male who presented with multiple erythematous nodules and verrucous lesions over the malar areas, nose, and forehead along with nasal obstruction and dysphagia. He gave a past history of receiving treatment for nasal rhinosporidiosis. We report this rare case of disseminated rhinosporidiosis with cutaneous involvement.

English

OBJECTIVE: The purpose of this study is to determine the prevalence of rhinosporidiosis in various groups of people & to know the various possibilities of extra nasal presentation as well as manifestations, so that the disease can be diagnosed early & proper treatment can be given at an early date. STUDY DESIGN: Prospective study. SETTINGS: Tertiary referral center [VSS Medical College, Burla.] MATERIAL & METHODS: For the observation on various presentations of rhinosporidiosis, the patients coming with mass in nose, complaining of nasal obstruction or recurrent epistaxis, & in mass in the other site of the body suspected to suffer from rhinosporidiosis were studied, treated & followed up in the department of ENT, VSS Medical College Hospital, Burla, Sambalpur. All such cases from September 2010 to August 2012 were taken into account. Their detailed history taken & their treatment is followed up. The results obtained are presented. RESULTS: Nose was the most common [MC] site of rhinosporidiosis. In the extranasal presentation nasopharynx is the MC site. Other sites are eye, skin & larynx. Common age group of involvement is 21–30 years. Males are affected more. The disease is prevalent among rural population. Nasal obstruction & epistaxis are the MC presenting symptom in nasal rhinosporidiosis. In nasopharyngeal cases foreign body sensation, stuffiness in ear & speech defect are the presenting symptoms. Ocular cases mostly presented with mass in conjunctiva or foreign body sensation in eye with bloody discharge. CONCLUSION: Atypical presentation of rhinosporidiosis in head and neck region is rare. Very often, this atypical presentation causes dilemma in diagnosis and creates confusion. Diagnosis of rhinosporidiosis should be kept in mind in all granulomatous lesions involving the mucous membranes in the endemic area.

Nasal Rhinosporidiosis: A Case Report and Review of Literature

Rhinosporidiosis is a rare infective chronic granulomatous lesion cause by Rhinosporidium seeberi, which is endemic in some part of Asia, although sporadic cases seen in America, Europe and Africa. The lesion presents as a soft tissue mass of the nose (primary site), eye and urethra. The organism is difficult to culture and the diagnosis is based on microscopy and histological examination of the lesion. Nasal rhinosporidiosis is uncommon disease in our environment which mimics neoplasm in its clinical features. We report a case of nasal rhinosporidiosis in an 18 year old male rural farmer from North Eastern Nigeria.

Nasal Rhinosporidiosis in a Nigerian Child: A Rare Clinical Entity

Background: Rhinosporidiosis is a rare chronic granulomatous disease characterized by polypous lesion of the mucous membrane caused by rhinosporidium seeberi which predominantly affects the mucous membrane of the Naso-pharynx, conjuctiva and palate. Rhinosporidiosis can be easily misdiagnosed as a neoplastic disease, and hence, it is necessary to educate the public and medical community about this emerging disease entity in our region. Aim: To report a rare case of nasal rhinosporidiosis in a 13-year-old male patient from Sokoto, North Western Nigeria. Case Report: A 13-year-old male Quranic child from gwadabawa village in Sokoto State, North Western Nigeria, whose parents are rice farmers, presented in the ENT clinic of Usmanu Danfodiyo University Teaching Hospital with 15-month history of intermittent epistaxis and left nasal mass noticed one month before presenting. He was examined clinically and a pinkish polypoidal mass arising from the septum and filling the left nasal cavity was seen. He subsequently had a biopsy of the mass and histopathological examination with special histochemical staining, which confirmed rhinosporidiosis. Conclusion: Rhinospridiosis is an unusual cause of nasal masses in our region and is probably a fungal disease. To the best of our knowledge, this is the first reported case in this region. This lesion largely mimics ordinary nasal polyp; therefore, it is an important possible differential diagnosis to be considered in our region when evaluating patients with nasal masses.

English

Rhinosporidiosis is a chronic infection caused by an organism called Rhinosporidium seeberi. It primarily affects the mucous membrane of the nose & nasopharynx. Involvement of other mucosal surfaces in the body has been reported but are extremely rare in occurrence. We are presenting a rare case of laryngeal rhinosporidiosis in a 36 year old male who presented with hoarseness of voice and progressive respiratory distress. He had previous history of multiple surgeries for nasal rhinosporidiosis.

A rare case of disseminated Rhinosporidiosis highlighting the need for specific management protocol

Rhinosporidiosis is a chronic, recurrent, infective, granulomatous disease of man and animals. It is endemic in Southern India and Sri Lanka. Rhinosporidiosis commonly involves the nose and the nasopharynx. Cutaneous lesions, although rare, can occur due to auto-inoculation or haematogenous spread; however lymphatic spread in the head and neck region has not been documented in the English literature. We document here an immuno-competent gentleman who had multiple, painless, cutaneous lesions secondary to primary nasal Rhinosporidiosis, presenting at different points in time over a period of 10 years and over various parts of the body. Histopathological examination revealed the spread of the fungal spores, through the lymphatic channels of the head and neck, to the upper cervical lymph nodes and the skin of the submandibular region, coupled with haematogenous spread to the lower limb. We have, accordingly, suggested need for a specific protocol for the management of Rhinosporidiosis.

Bronchial rhinosporidiosis: An unusual presentation

Rhinosporidiosis is a granulomatous disease that usually affects the nasal mucosa and nasopharynx. The disease is widely prevalent in the tropics, especially in southern India and Sri Lanka. In central India, rhinosporidiosis is endemic in Raipur, Chhattisgarh. Involvement of the tracheobronchial tree is extremely rare. Only two cases of bronchial rhinosporidiosis had been reported in world literature. We report a third case of bronchial rhinosporidiosis which occurred in a patient with coexisting nasal and nasopharyngeal rhinosporidiosis. Bronchoscopic guidance excision of mass and electric cauterization of base was done under local anesthesia.

Human nasal rhinosporidiosis: a case report from Malawi

Rhinosporidiosis is a rare chronic granulomatous disease, characterised by polypous lesions of the mucous membrane. Commonly affects the mucous membrane of the naso-pharynx, conjunctiva and palate. Its causative agent is Rhinosporidium seeberi. The disease is more prevalent in the Indian subcontinent, but remains quite rare in our environment. We hereby present a case description of a 70 year old native Malawian male with a polypoid nasal rhinosporidiosis. Patient presented with long standing history of nasal obstruction and intermittent epistaxis for three years. Diagnosis was confirmed by histopathological examination and he was successfully treated by complete surgical excision. This was a very unusual cause of nasal masses in our setting. Nasal rhinosporidioss lesions may largely mimic other ordinary nasal polyps, it is crucial therefore for clinicians in our region to consider rhinosporidiosis as a differential diagnosis when assessing patients presenting with nasal swellings.

Human nasal rhinosporidiosis: a case report from Malawi

Human nasal rhinosporidiosis: a case report from Malawi

Disseminated cutaneous, laryngeal, nasopharyngeal, and recurrent obstructive nasal rhinosporidiosis in an immunocompetent adult: a case report and review of literature

Disseminated cutaneous, laryngeal, nasopharyngeal, and recurrent obstructive nasal rhinosporidiosis in an immunocompetent adult: a case report and review of literature

A rare case of laryngeal rhinosporidiosis

Rhinosporidiosis is chronic granulomatous disease of likely fungal etiology which usually affects the nasal mucosa. Extranasal manifestations of rhinosporidiosis are relatively uncommon. Laryngeal and tracheobronchial tree involvement is extremely rare and only six cases have been reported till date. Here we report a case of laryngeal rhinosporidiosis, which occurred in a patient with coexisting nasal rhinosporidiosis and was successfully managed surgically.

Nasal rhinosporidiosis in humans: new interpretations and a review of the literature of this enigmatic disease

Rhinosporidiosis is a disease caused by Rhinosporidium seeberi which primarily affects the mucosa of the nose, conjunctiva and urethra. While it is endemic in some Asian regions, isolated cases are reported in other parts of the world as a result of the socio-cultural phenomenon of the migration. Its manifestation is a polypoid mass growing inside the affected cavity and the only treatment is surgical excision. Rhinosporidiosis is a condition which both clinicians and microbiologists should keep in mind when managing patients with nasal masses even those from non endemic areas. It is critical in such cases to follow the clinical course to ensure against recurrence of the disease. This study describes the clinical features, diagnosis, and treatment of rhinosporidiosis of the nose and nasopharynx in a series of three cases in East Delhi, India.

Nasal Rhinosporidiosis Revisited

AbstractRhinosporidiosis is a rare chronic granulomatous disease caused by rhinosporidium seeberi. Nasal rhinosporidiosis presents with nasal mass, nasal obstruction and epistaxis. In this study, we present our experience in 17 patients of rhinosporidiosis. Diagnosis was made on clinicopathological features. Different clinical presentations, management by surgical, combined with medical line of treatment are discussed with review of literature

Nasal Rhinosporidiosis in Two Dogs Native to the Upper Mississippi River Valley Region

Two dogs, 4 and 7 years of age, were presented for evaluation and treatment of excessive sneezing. Physical examinations in both cases were within acceptable limits except for the presence of a single mass in the left nasal passage in the first case and left-sided nasal discharge in the second case. Rhinoscopy was used to visualize the nasal masses, and in both cases a single mass was surgically removed. Impression smears and histopathology submitted from each mass revealed lymphoplasmacytic and neutrophilic inflammation with spores typical of Rhinosporidium seeberi. These are the first reported cases of nasal rhinosporidiosis in two dogs native to the Upper Mississippi River Valley area with no travel history outside the region.

Rhinosporidiosis in Delhi, North India: Case Series from a Non-endemic Area and Mini-review

We report three cases of rhinosporidiosis from migrant population of Delhi. Three male patients had sino-nasopharyngeal, nasopharyngeal and nasal rhinosporidiosis, respectively. One patient gave a history of bathing in stagnant water. The diagnosis was made by clinical presentation and microscopic observation of characteristic sporangia of Rhinosporidium seebri in mycological and histopathological investigations. All the patients were successfully treated with complete surgical excision of lesions and cauterization of base. There were no recurrences.

Disseminated cutaneous rhinosporidiosis: Varied morphological appearances on the skin

Rhinosporidiosis is a chronic granulomatous disorder caused by Rhinosporidium seeberi . It frequently involves the nasopharynx and occasionally affects the skin. We report a case of 45-year-old man who had disseminated cutaneous rhinosporidiosis with cutaneous pseudohorn, its base arising from rhinosporidiosis. The case presented with multiple reddish lesions over the nose of six years duration. In the past year, he developed skin lesions over the left arm, forearm, back, and chest. On examination, polymorphic lesions of rhinosporidiosis in form of verrucous plaque, unulcerated tumor, granulomatous growth, and furunculoid lesions were observed. Interestingly, there was a cutaneous horn over the chest which on histopathological examination showed hyperplastic epithelium with numerous globular cysts of varying shape, representing sporangia in different stages of development and transelimination. Computerized tomography scan of the chest showed bilateral opacities suggestive of lung involvement. On the basis of these clinical and histopathological findings, a diagnosis of nasal rhinosporidiosis with cutaneous and systemic dissemination was made.

Polymorphic ecthymatoid dermosporidiosis

We report the case of a young Chhattisgarhi male with polymorphic dermosporidiosis (cutaneous rhinosporidiosis). He had multiple subcutaneous nodules and an ecthymatoid skin lesion along with nasal rhinosporidiosis. The diagnosis was confirmed by demonstration of sporangia with endospores in fine-needle aspiration cytology (FNAC), histopathology, and imprint smear from the skin lesions. Treatment was by surgical excision, electrocoagulation, and dapsone. There was no recurrence. Dermatologists should be aware of the diverse cutaneous manifestations of this primarily nasal disease. This is the second published report of polymorphic dermosporidiosis, and the first one reporting an ecthymatoid lesion.

Rhinosporidiosis of the nose in the southern region of the Kingdom of Saudi Arabia

Rhinosporidiosis is a chronic fungal infection caused by Rhinosporidium seeberi . It selectively strikes two target zones: nasal and conjunctival mucosae. Patients with nasal rhinosporidiosis usually present with nasal obstruction, discharge, epistaxis and mass lesions. This investigation presents the first indigenous case of tumoral rhinosporidiosis in the southern region (Assir province) of the Kingdom of Saudi Arabia. A 78-year-old male patient from a rural background of Assir region presented with epistaxis, nasal obstruction, discharge and a polympoid mass. The patient had not traveled abroad. Diagnosis was established on the morphological ground by the identification of l5- to 10-micron endospores and 50- to 1,000-micron sporangia. The morphologic features were examined using histochemical stains. The relevant monographs and case reports are discussed.

Human nasal rhinosporidiosis: an Italian case report

BackgroundRhinosporidiosis is a disease affecting primarily the mucosa of nose, conjunctiva and urethra. It is endemic in some Asiatic regions, affecting people of any age and sex. Its manifestation is a polypoid mass growing inside the affected cavity and the only treatment is surgical excision. Rhinosporidium seeberi is the aetiological agent. Many discussions arouse regarding the taxonomic classification of the microorganism, recent studies established it is an aquatic protistan parasite. The lesion may recur and sometimes cause osteolytic bone lesions. In endemic areas it is not easy to establish if recurrent lesions are due to relapse or reinfection.Case presentationA 26-year-old male patient from India, resident in Italy since 2005, presented in March 2006 with a history of nasal obstruction of three months duration. Physical examination showed an erythematous, papillomatous mass, 3 cm in diameter, obstructing the right nasal cavity. A microscopic diagnosis of rhinosporidiosis was made. Few Italian human cases of this disease have been previously reported in the literature.ConclusionRhinosporidiosis is a condition which both clinicians and pathologists should keep in mind when managing patients from endemic countries with nasal masses. Moreover, it is very interesting in such cases to follow the clinical course: an eventual recurrence of the lesion in our patient would mean a true relapse, excluding the possibility of a reinfection, more probable in the endemic areas.