Educational report: A case of lacrimal sac rhinosporidiosis

Abstract

This article reports a presentation of lacrimal sac rhinosporidiosis and informs the reader of this uncommon but important diagnosis. A 36-year-old man from Pakistan presented with a 3-month history of swelling at the nasal aspect of the left lower lid. This was associated with occasional crepitus and slight localised discomfort, but no epiphora. There was a palpable fullness near the left medial canthus associated with telecanthus but a normal sac washout and normal eye examination otherwise. Previous medical history included an ipsilateral nasal polypectomy and inferior meatal antrostomy around 10 years previously, whilst living in Pakistan. Various imaging modalities were useful in identifying a soft tissue mass within the left nasolacrimal duct. Following excision biopsy, histological examination confirmed the presence of rhinosporidiosis, likely caused by the organism Rhinosporidium seeberi. Rhinosporidiosis should be considered as a potential cause in any case of lacrimal sac pathology. Imaging studies may be helpful in measuring the extent of disease, although histological examination is required to confirm the diagnosis. Although rare, the complications of rhinosporidiosis can be potentially blinding or fatal. As discussed in this case, the presence of telecanthus may represent a lacrimal system tumour, either malignant or benign, and should always prompt further investigation.

Lacrimal sac rhinosporidiosis: case report and review of literature with a new grading system to optimize treatment

“…The swelling was fluctuant[1], [16] and boggy[7], [9], [33] and felt like a bag of worms 24 . It was painless in most of the studies,[1], [2], [9], [10], [15], [16], [18], [26], [34], [5], [6], [7] while some of them reported tenderness over the swelling [21], [22], [31]…”

“…Epiphora may be absent in some cases of nasolacrimal rhinosporidiosis[32], [34] because the spread of infection is peri-canalicular and perisaccal 27 . However, epiphora when present, may be continuous[3], [9], [11] intermittent[9], [14], [18] or blood stained [10], [21], [23].…”

“…However, epiphora when present, may be continuous[3], [9], [11] intermittent[9], [14], [18] or blood stained [10], [21], [23]. NLD was fully patent in some studies,[11], [20], [24], [32], [34] partially patent in others 14 and completely blocked in the rest [1], [3], [27], [30], [35]…”

“…DCG showing diverticulaVia Ant orbitotomy through sub ciliary approach diverticula was removed leaving sac behind. It recurred with fistula with discharging spores1st postop day1 yearIodine + AmoxyclavPresentWest Bengal (India)5Girish and Prathima 27 20171Diffuse nontender infra orbital swelling of the left eyeMucopurulent dischargeNMIntermittentLS + NLDHyperdense lesion in subcutaneous plane in left infraorbital regionDCT with enbloc resection of NLD.NMNM100 mg x3 monthsPresentNorth Eastern part of India6Jamison et al 34 20161Swelling at nasal aspect of left lower lid.NMPatentAbsentLS, NLD & noseCT-DCG- donut distribution i.e. contrast passed through NLD in circumferential manner till it drained in IM, with asymmetry in lateral wall of noseGelatinous lesion attached to superior wall of lacrimal sac extending into NLD.…”

External dacryocystorhinostomy for isolated lacrimal sac rhinosporidiosis – A suitable alternative to dacryocystectomy

“…It is therefore not surprising that the most commonly recommended treatment modality for lacrimal sac rhinosporidiosis in the literature is complete excision of the infected lacrimal sac or DCT. [1231112] This modality, though apparently safe and curative, also produces constant and debilitating postoperative epiphora in the patient that is difficult to relieve. In contrast, a DCR performed after excision of the sac granuloma with appropriate precautions is a suitable alternative that appears to have very good long-term outcomes as suggested by the authors’ study.…”