Recurrent rhinosporidiosis: a case report

Abstract

Rhinosporidiosis is rare infective chronic granulomatous lesion cause by Rhinosporidium seeberi which occurs universally although endemic in South Asia, notably in Southern India and in Srilanka. The causative agent Rhinosporidium seeberi is intractable to isolation and microbiological culture and shows features of both fungi and protozoa. The great majority of cases occur in upper respiratory sites, notably the anterior nares, nasal cavity-the inferior turbinate's, septum and floor. It is a chronic disease, with frequent recurrence after surgery and occasional dissemination from initial focus .Rhinosporidial lesions in the nasal passages are Polypoidal, granular, red in colour due to pronounced vascularity, with a surface containing yellowish pin head sized spots which represents underlying mature sporangio. The organism is difficult to culture and diagnosis is based on microscopy and histological examination of the lesion. The mainstay of treatment is meticulous complete and wide surgical excision, followed by electro-cautery of the base may ablate recurrence resulting from the spillage of endospore on the adjacent mucosa and recently use of laser is also indicated. We present a thrice operated recurrent case of extensive Rhinosporidiosis involving left nose & nasopharynx where the disease was removed using bipolar cautery, microdebrider and laser assisted.

Recurrent Nasal Rhinosporidiosis: A Case Report

“…Nasal Rhinosporidiosis is clinically defined as single pedunculated polyp, multiple sessile polypoid tumours.Commonly ordinary polyp arises from middle turbinate, rhinosporidiosis usually involve mucosal lining of naso-pharynx , inferior turbinate, septum or nasal floor .Hence nasal polyps originating from these locations should always be treated with high degree of suspicion . Wide &complete removal of polyp followed by electrocautery of the lesion's base is recommended for rhinosporidiosis (1,3,(4)(5)(6)(10)(11)(12). It is hypothesized that cauterization of lesion's base is mandatory to avoid recurrence resulting from spillage of endospores to the adjacent tissue (1,2,4,5,11).…”

“…Lesions involving other regions of the body like brain, trachea, ear, skin and subcutaneous tissues have been reported which are rare (1)(2). Through molecular biology this organism has demonstrated characteristics of aquatic protistan parasitic microbe and now it has been classified as mesomycetozoea, along with 10 other parasitic and saprobic microbes (1,3). This infection do not show racial predilection although exhibit male gender preponderance.…”

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“…The definitive diagnosis of Rhinosporidiosis is by histopathology with the identification of the pathogen in its diverse stages, rather than the stromal and cellular responses of the host. 2,5 Surgery by hot or cold snare technique is the treatment of choice and endoscopic removal of naso-oropharyngeal polyps is also practiced (Arun et al 2009). Most patients with localized disease respond to treatment with Tablet Dapsone (which appears to arrest the maturation of the sporangia and to promote fibrosis in the stroma) following surgical excision.…”

“…Total excision of the mass, preferably by electro-cautery, is recommended. 1,3,5,6 However Laser provides adequate cauterization with good haemostasis thereby reducing the chances of complications and recurrence. 7 Hence in our case CO 2 laser was used over the surface attachments at nasal septum upto posterior choana and nasopharynx roof to minimise recurrence .Laser can be used as an adjunct during surgery and all measures to be taken so that the disease is removed completely and its attachments are cauterized or laserised after disease bulk removal.…”

“…2 Hypothesized modes of spread, most common being 'Auto-inoculation' responsible for the occurrence of satellite lesions adjacent to granulomas especially in the upper respiratory sites and for local spread, others being haematogenous spread and lymphatic spread. 2,3,5 Case report 48 year old male coast guard personnel, a known case of Primary Hypertension and Type II Diabetes Mellitus, presented to this centre with Left nasal mass and bleeding from Left nostril of 04 months duration. There was history of similar complaints for the past 23 years.…”