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

Rhinosporidiosis is a chronic infection of the mucous membrane caused by the Rhinosporiduim seeberi, which infects through transepithelial penetration. Although described worldwide, this entity is mostly found in the western hemisphere, afflicting young people, predominantly males, associated in many cases with recreational or professional contact with bath in ponds, rivers, or stagnant waters. The clinical features are varied depending on the affected membrane, in some cases mimicking other diseases postponing the correct diagnosis. Although nasal obstruction and epistaxis are the common clinical presentations in sinonasal rhinosporidiosis, patients with epiphora without a nasal mass often challenge the diagnosis. In the present case, we have documented a case of isolated lacrimal sac rhinosporidiosis masquerading as chronic dacryocystitis, which was successfully managed by endoscopic excision, accompanied by a literature review.

Rhinosporidiosis: the largest case series in Brazil

Abstract: INTRODUCTION: Rhinosporidiosis is a chronic infection of the mucous membrane and is caused by Rhinosporidium seeberi, an aquatic mesomycetozoan. The mode of infection is probably transepithelial penetration. The large number of rivers and lakes and the strong presence of riparian populations in the State of Maranhão are strong predisposing factors for rhinosporidiosis. METHODS: A 5-year retrospective study was conducted in a tertiary medical center situated in Maranhão, Northeast Brazil. Twenty-five Maranhense patients diagnosed with rhinosporidiosis were analyzed. RESULTS: Most of the patients were children, adolescents and young adults (age range: 7-24 years, mean age: 14 years). The majority of the participants were male (84%), brown (76%), and students (92%). All lesions involved the entire nasal cavity and presented with a vascular polypoid mass. All patients were treated by surgical excision of the lesions. CONCLUSIONS: Rhinosporidiosis affects younger age groups, especially students from the countryside and the outskirts of urban areas. This study will aid and guide physicians in diagnosing and treating this infection in endemic areas.

Rhinosporidiosis: a clinicopathological study from a Rural Tertiary Health Care Centre, Bihar, India.

Rhinosporidiosis is a chronic granulomatous infection characterized by a bleeding polypoidal mass which commonly affects the nose and nasopharynx. The disease is caused by Rhinosporidium seeberi. It grows in stagnant water and is thought to be transmitted to human by infected soil and water by gaining entry through traumatized epithelium and mucosa of nose and nasopharynx. It has a high incidence of occurrence among rural population. Surgical excision is the treatment of choice. Methods: Totally, 26 patients of histologically proven cases of rhinosporidiosis were included in this clinicopathological study. The mode of presentation in all these patients was polypoidal nasal mass causing recurrent bleeding and nasal obstruction. The period of study was from May 2010 to April 2014. All patients treated surgically were followed-up from 6 months to 1 year. Results: There were 26 patients of histologically proven rhinosporidiosis of nose and nasopharynx. Of total 26 cases, there were 19 males and 9 female patients in our study with a male to female ratio of 2.7:1. The age of presentation varied from 14 years to 67 years, most patients presenting in the second to sixth decade of life with maximum patients in the third and fourth decade of life and were from rural and poor socio-economic background. Recurrent cases were given dapsone. Conclusion: Rhinosporidiosis which was previously thought to be a fungus is now considered as a protoctista parasite, which involves fish and other amphibians, a fungus like protozoa of the class mesomycetozoea.

Diagnóstico diferencial de la rinosporidiosis: a propósito de un caso / Differential diagnosis of rhinosporidiosis: report of a case

Se informa un caso de rinosporidiosis, enfermedad granulomatosa crónica rara, producida por Rhinosporidium seeberi. El paciente fue un hombre procedente de área rural en el departamento de Bolívar (Colombia) que consultó por obstrucción nasal y epistaxis unilateral. Se le encontró una masa nasal de aspecto polipoide vegetante, similar a la de un papiloma invertido rinosinusal, cuya biopsia fue leída como granulomatosis por rinosporidiosis. Se le hicieron resección endoscópica y tratamiento complementario con diaminodifenilsulfona 100 mg/día por tres meses. La evolución fue favorable. Se debe tener en cuenta la rinosporidiosis en el diagnóstico diferencial de las masas nasales benignas no solo en pacientes que proceden de zonas endémicas. El estudio anatomopatológico es imprescindible para el diagnóstico definitivo. Por los casos esporádicos en Colombia se sugiere el reporte epidemiológico para identificar posibles fuentes de contagio y personas con manifestaciones extranasales de esta enfermedad.

We report the case of a man with rhinosporidiosis, an infrequent, chronic granulomatous disease; he lived in a rural area in northwestern Colombia, and came to the hospital because of nasal obstruction and unilateral epistaxis. A polypoid mass was found similar to that of an inverted sinusal papilloma. Biopsy revealed a granulomatous lesion due to rhinosporidiosis. Endoscopic resection was carried out and diaminodiphenylsulfone was administered (100 mg/day for 3 months). Evolution was favorable. Rhinosporidiosis must be taken into account in the differential diagnosis of benign nasal masses, not only in endemic areas. Histopathological study is necessary for diagnosis. We suggest that epidemiological report of rhinosporidiosis cases is done in order to identify possible sources of the infection as well as persons with extra-nasal manifestations of this disease.