AIIMS doctors report a rare case of nasal mass due to Rhinosporidiosis

Written by Hina Zahid Published On 2019-04-04T18:00:44+05:30 | Updated On 4 April 2019 6:00 PM IST

All India Institute of Medical Sciences, (AIIMS) New Delhi, India doctors Dr Chirom A. Singh and Pirabu Sakthivel has reported a rare case of Rhinosporidiosis. The case has appeared in the NEJM.

Rhinosporidiosis has been known for over 100 years since its first description in Argentina. It is a rare chronic granulomatous disease endemic in some areas of Asia, such as south India and Sri Lanka.

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 the recurrence of the disease

According to history, a 27-year-old man presented to the otorhinolaryngology outpatient clinic with a 3-month history of progressive obstruction and bleeding from the right naris. Physical examination showed a red, granular, pedunculated, nonpulsatile mass that obstructed the right nasal cavity and bled on touch (Panel A). The patient reported bathing frequently in the local pond.

The mass was excised, and the base of the lesion was cauterized. Histopathological examination revealed multiple thick-walled sporangia in various stages of maturation, surrounded by dense inflammation (Panel B, hematoxylin and eosin). A diagnosis of rhinosporidiosis was made. Rhinosporidiosis is a chronic granulomatous disease caused by the aquatic protistan parasite Rhinosporidium seeberi.

The typical presentation is a reddish, friable mucosal polyp, commonly involving the nasal cavity, that bleeds profusely on touch. The oropharynx, conjunctiva, rectum, and external genitalia may also be affected. At follow-up 8 months later, the patient had areas of recurrence in the nasopharynx that were removed.

For more details click on the link: DOI: 10.1056/NEJMicm1811820

Bleedingchronic granulomatous diseaseconjunctivadapsone therapyfriable mucosal polypgranularlocal pondnasal massnasal obstructionnonpulsatile massoropharynxOtorhinolaryngologypedunculatedrectumreddishRhinosporidiosisRhinosporidium seeberiright narissurgical excision

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Hina Zahid