Atypical Presentations of Rhinosporidiosis: A Clinical Dilemma?

Abstract

Rhinosporidiosis is a chronic inflammatory disease common in India and Sri Lanka. Its manifestations are mostly nasal, though extranasal ones in head and neck region are not rare. Occasionally these presentations lead to diagnostic dilemma. Here we present some cases with its associated confusions if any. In this study thirty five patients were included. Extranasal manifestations were noted in nine cases. Two patients attended with laryngopharyngeal and one with lacrimal sac presentation-subsequent nasal endoscopic examination revealed presence of nasal masses, too. Other six cases presented with polypoidal mass hanging from nasopharynx into oropharynx. One of them was confused with nasopharyngeal angiofibroma. Two laryngopharyngeal masses were removed successfully with rigid laryngoscope followed by cauterisation of the base. The solitary lacrimal sac mass was excised by external approach combined with nasal endoscope guided excision of nasal mass. The other six cases with nasopharyngeal attachment were subjected to nasal endoscope guided removal. In all these cases, the base of the lesions was cauterised. The experience about the various manifestations and diagnostic problems is discussed here.

Cytodiagnosis of extra-nasal rhinosporidiosis: A study of 16 cases from endemic area

“…[ 7 ] Rhinosporidiosis is more prevalent among males in the age group of 10-40 years. [ 3 ] Similarly, male patients were more frequent in our series (10 cases out of 16; 62.5%) and majority were young aged (13 cases are in the age group of 11-30 years; 81.25%). Mode of infection is supposed to be trans-epithelial inoculation of organism in traumatized epithelium.…”

“…Rhinosporidiosis was discovered by Malbran, as a sporozoon in 1892. [ 2 3 ] The same organism was first published by Seeber in 1900 and Ashworth describes its lifecycle in 1923. [ 6 ] Taxonomy of R. seeberi is still debatable and in last decade it was concluded that it is not a classic fungus, rather a human pathogen from Dermocystidium , the Rossette Agent, Ischthyophonus and Psorospermium clade - a clade of aquatic protistan parasites.…”

“…[ 1 2 ] India and Sri Lanka are the endemic regions for rhinosporidiosis due to temperate climate. [ 3 ] Rhinosporidiosis is caused by an organism of mesomycetozoea group known as Rhinosporidium seeberi . [ 1 ] Majority of the cases are sporadic but >90% of cases occur in South East Asia.…”

“…[ 4 5 ] Extra-nasal (atypical) sites of rhinosporidiosis are orbital region, lip, palate, uvula, larynx, trachea, buccal cavity, lacrimal sac, scalp, skin, penis, urethra, vulva, and bone. [ 1 2 3 ] Presumptive diagnosis of primary rhinosporidiosis at extra-nasal site is often difficult. Some cases of extra-nasal rhinosporidiosis are associated with nasal involvement also.…”

Rhinosporidiosis presenting as an oropharyngeal mass: A clinical predicament?

“…[ 1 2 ] It is a cosmopolitan disease of human and domestic animals, prevalent in hot tropical climate of endemic zones like India, Sri Lanka, East Africa, parts of America and also encountered among expatriate population in the West. [ 3 4 ] Water and soil are the main reservoirs of infection and the endospores are transmitted through water and dust into the nasal mucosa by traumatic inoculation where they mature subepithelially and after maturation burst with release of sporangia into the tissues. [ 5 ] RS is characterized by a reddish, friable, polypoidal, hyperplastic mass mostly occurring in the nasal cavity and nasopharynx, however, sporadic occurrence in extra nasal sites is also observed.…”