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

Abstract

Rhinosporidiosis is a chronic granulomatous disease affecting the mucous membrane primarily and is caused by Rhinosporidium seeberi, an aquatic protistan parasite. The nose is the most common site of involvement and is seen in 83.3% cases, followed by ocular involvement in 11.2% cases and other sites like larynx, trachea and bronchus in 5.5% cases. In various oculosporidiosis case series, lacrimal drainage system involvement was seen to vary from 14.3% to 59.6% cases. Isolated lacrimal sac involvement in rhinosporidiosis was found in 45.8% (72 out of 157) cases of the lacrimal drainage system in a review of 31 studies.A variety of surgical procedures have been used to treat rhinosporidiosis of lacrimal sac like dacryocystorhinostomy, Dacryocystectomy, lateral rhinotomy and local lesion excision with a success rate varying from 28.5% to 92.3%. This wide variation in the success rate was due to the fact that a uniform surgical procedure was performed in all the cases of a particular series irrespective of the extent of disease.Grading the lacrimal sac rhinosporidiosis to decide the extent of surgical excision may help achieve better results. We present a grading system based on our own experience in a case of extensive rhinospodiosis of lacrimal sac and review of 31 studies published in the literature.A 24-year-old male from Nepal presented with the complaints of watering from his right eye of 13 years duration, swelling in the right medial canthal area with an extension to the inferior part of the orbit for 12 years and nasal blockage for 1.5 years. The patient had a history of previous intervention in which biopsy was taken from the nose and sent for histopathology that confirmed rhinosporidiosis. An extended intranasal endoscopic dacryocystectomy was done along with debridement and coblation of the lesion over the septum and nasopharynx. Intraoperatively a large rhinosporidiosis mass was seen filling the sac and was removed in toto along with the sac and nasolacrimal duct. Recurrence of a tiny lesion after 6 months in our case despite wide excision with the drilling of bony nasolacrimal duct and coblation, made us review the literature.

Nasal rhinosporidiosis masquerading as pyogenic granuloma in a pediatric patient at a Zonal Referral Hospital in Central Tanzania: Case report

“…9 In terms of race and sex predilection, there is no racial predominance and males are more affected than females, especially those aged 15-40 years with male to female ratio being 4:1. 2,10,11 Rhinosporidiosis may be transmitted by direct contact with spores through dust, infected clothing, and swimming in stagnant water. 7,8,12,13 However, the disease remains to be very rare in our country; yet, there are some countries that have reported several cases including Nigeria.…”

Rhinosporidiosis—Factors predicting disease recurrence

“…Dapsone (diamino‐diphenyl‐sulphone) has been beneficial in reducing the rate of post op recurrence. It acts by inhibiting the division of the organism and maturation of its spores and accelerating its degeneration by granulomatous response 20,21 . In our cohort, four of the five patients who did not take dapsone after the surgery developed later recurrence.…”

“…It acts by inhibiting the division of the organism and maturation of its spores and accelerating its degeneration by granulomatous response. 20,21 In our cohort, four of the five patients who did not take dapsone after the surgery developed later recurrence. Currently, dapsone is recommended at a dose of 100 mg/day for a minimum of 6 months to prevent recurrence.…”

Rhinosporidiosis of the lacrimal sac masquerading as chronic dacryocystitis: a rare presentation

“…The majority of the patients are managed through external dacryocystorhinostomy. 21,26,28,30,31,35,37 In contrast, in the present case, the mass was excised through a transnasal endoscopic procedure, similar to the standard endoscopic dacryocystorhinostomy, as described by Gupta et al 14 Although medical treatment cannot be denied, its role is very much limited to patients where complete surgical resection is not possible due to the systemic spread of the disease. Dapsone, because of its anti rhinosporidial activity, can be used to arrest the maturation of sporangia and to promote fibrosis in the stroma.…”