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 in horses / Rinosporidiose em equinos

Rhinosporidiosis is a disease caused by Rhinosporidium seeberi, an aquatic protist of the class Mesomycetozoa. It primarily affects the nasal mucosa and transmission is associated with contaminated water contact. This report describes seven cases of rhinosporidiosis in horses in Rio Grande do Sul covering the period of 13 years. The disease predominantly affected Crioulo and thoroughbred horses. No apparent gender predisposition occurs, and age ranged from two to 25 years, with a median of 10 years. The gross aspects were characterized by unilateral (85.7%, 6/7) or bilateral (14.3%, 1/7) polyps. These were soft to friable, whitish to pink, cauliflower-like, with an irregular, sometimes ulcerated surface, measuring 2.5 to 6.0cm in diameter. There was a severe inflammatory infiltrate of the submucosa was observed, associated with moderate proliferation of the epithelium, and numerous rounded structures were identified compatible with sporangia of R. seeberi. Rhinosporidiosis should be included in the differential diagnosis of other conditions affecting the respiratory tract of horses, and it is important to perform histopathology for diagnosis.(AU)

A rinosporidiose é uma doença causada por Rhinosporidium seeberi, protista aquático da classe Mesomycetozoa. Acomete principalmente a mucosa nasal e a transmissão está associada ao contato com água contaminada. Este trabalho descreve sete casos de rinosporidiose em equinos no Rio Grande do Sul em um período de 13 anos. A doença afetou predominantemente cavalos de raça, como Crioulo e Puro Sangue Inglês, sem predisposição sexual evidente e a idade variou de dois a 25 anos, com a mediana de 10 anos. Macroscopicamente foram caracterizadas por pólipos unilaterais (85,7%; 6/7) ou bilaterais (14,3%; 1/7). Os pólipos eram macios a friáveis, esbranquiçados a róseos, com aspecto de couve flor e com superfície irregular, por vezes ulcerada, medindo 2,5 a 6,0cm de diâmetro. Havia infiltrado inflamatório piogranulomatoso acentuado na submucosa associado à moderada proliferação do epitélio e numerosas estruturas arredondadas compatíveis com esporângios de R. seeberi. A rinosporidiose deve ser incluída no diagnóstico diferencial de outras patologias que acometem o trato respiratório de equinos, sendo importante a realização da histopatologia para diagnóstico.(AU)

Palatal rhinosporidiosis: an unusual case report and review of the literature

Rhinosporidiosis is a chronic, granulomatous, mucocutaneous infection caused by Rhinosporidium seeberi . The infection is non-contagious and sporadic in humans. The site most commonly affected is the mucous membrane of the nose and nasopharynx, followed by the oropharynx, trachea, bronchi, ear, eye, and genitourinary tract. It can also spread to other areas through blood and lymph. Here, we report a case of rhinosporidiosis affecting the palate in a 60-year-old female patient.

Rinosporidiosis nasal: reporte de un nuevo caso y revisión de la literatura / Nasal rhinosporidiosis: new case report and review

La rinosporidiosis es una enfermedad granulomatosa rara producida por el microorganismo Rhinosporidium seeberi. A pesar de ser considerada una infección endémica en algunas zonas de Asia, en nuestro país es una enfermedad extremadamente rara. Se presenta el caso clínico de un escolar de 10 años que consulta por aumento de volumen en fosa nasal izquierda de 1 mes de evolución, de crecimiento progresivo, con epistaxis autolimitada, presentando al examen físico una lesión polipoídea, en la cual, no existiendo sospecha previa, se determinó mediante histopatología la presencia de rinosporidio-sis. Se discute la epidemiología de la enfermedad, sus mecanismos de diseminación, alternativas de tratamiento y principales complicaciones.

Rhinosporidiosis is a rare granulomatous disease produced by the microorganism Rhinosporidium seeberi. Despite being considered an endemic infection in some areas of Asia, in our country it is an extremely rare disease. We present the case of a 10 year-old boy who consult for increased volumen in the left nostril of 1 month evolution, with progressive growth, self-limited epistaxis, and a physical examination with a polypoid lesion, in which there were no prior suspicion, histopathology determined the presence of rhinosporidiosis. Epidemiology of the disease, its dissemination mechanisms, treatment options and major complications are discussed.

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.

A Case of Rhinosporidiosis of the Nasal Cavity / 대한이비인후과학회지

Rhinosporidiosis is a chronic granulomatous infectious disease caused by Rhinosporidium seeberi, which is endemic to South India, Sri Lanka, and parts of Africa. It is primarily an infection of the nose. Although involvement of other parts of body has occasionally been reported, it rarely presents as a disseminated disease. We describe a case of nasal rhinosporidiosis in Korea and discuss its clinical manifestations and management.

Rinosporidiose nasal canina: relato de caso no Brasil* / Canine nasal rhinosporidiosis: case report in Brazil

O presente trabalho teve por objetivo descrever o primeiro relato de rinosporidiose canina no Brasil, discutindo suas principais características clínicas, etiológicas, patogênicas e seu diagnóstico. Um cão macho, sem raça definida, com histórico de massa nasal de crescimento lento há cinco meses, com sangramento nasal esporádico, foi encaminhado ao setor de cirurgia e realizada biópsia com posterior exame histopatológico. O resultado demonstrou a presença de estruturas encapsuladas compatíveis com esporângios de Rhinosporidium seeberi. O proprietário optou por não realizar o tratamento cirúrgico ou farmacológico, assim como não retornou para as revisões. Até o presente momento, este é o único caso de rinosporidiose canina obervado no país. Os achados clínicos foram comuns aos demais casos mundiais da doença. A coloração com Hematoxilina-Eosina foi simples e conclusiva. As massas polipoides, friáveis, em cavidade nasal, de pacientes que têm contato com água estagnada devem incluir o R. seeberi como diagnóstico diferencial.

This study aimed to provide the first report of canine rhinosporidiosis in Brazil, discussing its main characteristics clinical, etiologic, pathogenic and its diagnosis. A male dog, mixed breed, with nasal mass history of slow growth for five months, with occasional nasal bleeding, was submitted to the Surgery and biopsy conducted with subsequent histopathological examination. The results showed the presence of encapsulated compatible with sporangia Rhinosporidium seeberi structures. The owner chose not to conduct surgical or pharmacological treatment, and did not return to the revisions. To date, this is the only case of canine rhinosporidiosis observed in the country. Clinical findings were common to other global cases. Staining with Hematoxylin-Eosin was simple and conclusive. The polypoid masses, friable, in nasal cavity of patients who have contact with stagnant water should include R. seeberi as differential diagnosis.

Rhinosporidiosis of the Neck: A Rare Occurrence.

Rhinosporidiosis is a chronic granulomatous disease caused by a fungus Rhinosporidium seeberi, It frequently involves the nasopharynx and presents as a painless, friable, polypoidal growth hanging anterior to the nares or posteriorly into the pharynx. Th e lesions appear pink with minute white dots, which give it a strawberry-like appearance. Histopathologically, the organisms appear as sporangia containing large numbers of round or ovoid endospores. Several drugs have been tried, but Dapsone has proven to be most eff ective. In the present case, the lesion was seen on the anterior border of the mandible which is a very rare site for this infection. Th e growth was pedunculated and proliferative mimicking an aggressive lesion. On histology, also a rare fi nding of involvement of lymph nodes by the sporangia was noted.

Rinosporidiosis conjuntival diagnosticada mediante estudio histopatológico / Conjunctival rhinosporidiois diagnosed in a biopsy specimen

11 years old girl, from south region of Chile, without history of travels outside Chile nor the province, complaints of red eye with blepharitis and blood-tingued epiphora. Eye exam revealed a pseudomembrane. Clinical diagnosis was folicular conjunctivitis. A surgical removal was performed and the lesion sent to biopsy analysis. On microscopic examination numerous 50-150 μm cysts with keratinous wall and numerous endospores were found. Rinosporidiosis is an infection caused by Rhinosporidium seeberi that frecuently affects nasal cavity but could infect eye, urogenital tract and airways. This infections is considered endemic in Asia and Africa, but it is very important to have the suspicious among polyps in these areas because travel to endemic areas is become more frecuently.

Escolar de 11 años, de sexo femenino, proveniente de la Región del Bío-Bío, sin antecedentes de viajes, consultó por ojo rojo, blefaritis y epífora sanguinolenta; al examen oftalmológico reveló una pseudomembrana. La sospecha clínica fue de una conjuntivitis folicular. Se realizó la remoción quirúrgica de la lesión y en el estudio histopatológico se observaron lesiones características de rinosporidiosis, correspondiente a quistes de 50-150 μm con pared quitinosa y numerosas endosporas. La rinosporidiosis es una infección causada por Rhinosporidium seeberi, que afecta con mayor frecuencia la cavidad nasal, pero puede también afectar el ojo, aparato urogenital y la vía aérea, entre otros. Es considerado endémico en países de Asia y África, pero dado el aumento de viajes a estas regiones es importante reconocer este agente como causal de pólipos en la zona nasal y ocular.

Rhinosporidiosis of the parotid duct presenting as a parotid duct cyst - A report of three cases.

Rhinosporidiosis is a chronic granulomatous infection caused by Rhinosporidium seeberi. Rhinosporidiosis has been reported from many countries but is endemic in certain parts of India and Sri Lanka. The common sites of involvement are the nose and nasopharynx followed by ocular tissue. Rhinosporidiosis is also known to involve many rare sites and may become disseminated to occur in a generalized form. Rhinosporidiosis of the parotid duct is rare and only five reported cases could be found in the literature. We report three cases of rhinosporidiosis of parotid duct presenting clinically as a parotid duct cyst. Rhinosporidiosis was diagnosed by histopathology. None of these patients had rhinosporidiosis at any other site

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.

Rinosporidiosis ocular, presentación de tres casos y revisión de la literatura científica / Ocular Rhinosporidiosis. Report of three cases and review of scientific literature.

La rinosporidiosis ocular es una enfermedad muy poco común, causada por el parásito Rhinosporidium seeberi, la cual afecta diferentes órganos, entre ellos la conjuntiva. Debido a su poca frecuencia, es a menudo subdiagnosticada por oftalmólogos y patólogos. Se presentan tres casos que cumplieron con los criterios histológicos de la enfermedad y se revisan las características clínicas e histopatológicas de la misma.

Ocular rhinosporidiosis is a very rare disease, caused by the parasite Rhinosporidium seeberi, which affects different organs including the conjunctiva. Because of its rarity is often underdiagnosed by ophthalmologists and pathologists. We present three cases that fulfilled the histological criteria of the disease and reviewed its clinical and pathological characteristics.

Rinosporidiose: manifestação cutânea / Rhinosporidiosis: cutaneous manifestation

A rinosporidiose é uma doença infecciosa zooantropofílica mucocutânea causada pelo Rhinosporidium seeberi. Caracteriza-se por massa polipoide, séssil ou pedunculada, eritematosa, moriforme e friável, principalmente, nas mucosas nasais e oculares. A ocorrência na pele é ocasional, por disseminação a partir da mucosa adjacente, inoculação direta ou generalização via hematogênica. Os autores apresentam o caso clínico de um menino de oito anos de idade, com lesão isolada localizada no epicanto medial do olho direito.

Rhinosporidiosis is an infectious mucocutaneous disease caused by Rhinosporidium seeberi. It is characterized by sessile or pedunculated polyps which are erythematous, moriform and friable and which mainly affect the ocular and nasal mucosa. The occurrence of skin lesions is occasional and due to dissemination from the adjacent mucosa, direct inoculation or hematogenous dissemination. The authors report the clinical case of an eight-year-old boy with an isolated lesion located in the medial epicanthus of the right eye.

Tectonic corneal graft for conjunctival rhinosporidiosis with scleral melt.

A 16 year old girl presented with irritation and watering of the right eye for 3 months. On examination, the superior perilimbal sclera was ectatic with incarcerated uveal tissue covered by conjunctiva. The conjunctiva showed discreet, yellow white mucoid spots. Excision biopsy of the conjunctiva showed subepithelial spherules of sporangia containing numerous endospores, suggestive of rhinosporidiosis. Diathermy was applied to flatten the staphyloma. The ectatic area was covered with a corneal patch graft. The patient was started on prednisolone acetate eye drops and oral dapsone for 6 months. Corneal graft was well incorporated and conjunctivalized by 3 months. Since the graft was not seen within the palpebral aperture, there was good cosmetic result. The corneal graft had the added advantage of transparency which allowed visualization of the underlying tissue to diagnose early recurrence. There was no recurrence at 6 months.

Rhinosporidiosis of lacrimal sac: A rare case report from north east India.

Rhinosporidiosis usually affects the mucous membrane of nose and conjunctiva, less frequently lacrimal sac, urethra, and skin. This is a case presentation of rare lacrimal sac rhinosporidiosis for the first time reported from the state of Tripura in North East India. Diagnosis of rhinosporidiosis is usually made by routine histological examination and treatment is surgical excision. It needs follow up as recurrence is common.

Rhinosporidiosis of parotid duct.

Rhinosporidiosis is a benign chronic granulomatous infection caused by Rhinosporidium seeberi. Rhinosporidiosis is endemic in south Asia, notably in southern India and Sri Lanka. Majority of the cases have been reported to occur in upper respiratory sites, notably anterior nares, nasal cavity, nasopharynx, larynx and soft palate. Only two rare cases of involvement of parotid duct, have been reported in literature. Hence, this case will probably be the third to be reported.

Rinosporidiose nasal: diagnóstico diferencial de sinusite fúngica e papiloma invertido / Nasal rhinosporidiosis: differential diagnosis of fungal sinusitis and inverted papilloma

Introdução: Descrição de caso clínico de rinosporidiose, doença granulomatosa crônica e rara, causada pelo Rhinosporidium seeberi. Objetivo: Incluir esta doença nos diagnósticos diferenciais de lesões polipoides das fossas nasais. Relato do Caso: Paciente do sexo masculino, proveniente do norte do Brasil, evoluiu por 3 anos, com lesão polipoide papilomatosa, da fossa nasal esquerda. Realizada sinusectomia com remoção de toda lesão, centrada em bula etmoidal e processo uncinado. Diagnóstico diferencial foi de papiloma invertido ou sinusite fúngica. O exame histopatológico revelou acentuada infestação por numerosas estruturas fúngicas com formas de esporângios repletas de esporangiósporos. Os microorganismos eram positivos para as colorações de Grocott, PAS e Mucicarmim; ao contrário do Coccidiodes immitis, que não se contrasta pelo mucicarmim. Não se optou por tratamento complementar e após 1 ano de seguimento não existem sinais de recidiva. Comentários Finais: A rinosporidiose deve ser considerada como diagnóstico diferencial das lesões polipoides nasais. No diagnóstico das lesões intranasais deve-se sempre considerar a procedência do paciente. É obrigatório o estudo anátomo-patológico para definir o diagnóstico. Na rinosporidiose, a exérese cirúrgica pode ser curativa.

Introduction: Clinical case report of rhinosporidiosis, a rare and chronic granulomatous disease, caused by Rhinosporidium seeberi. Objective: To include this disease in the differential diagnoses of polypoid lesions of the nasal mass. Report: A male patient from the North of Brazil evolved a three-year papilomatous polypoid lesion of the left nasal cavity. He was submitted to sinusectomy with resection of the entire lesion, located in ethmoid bulla and uncinated process. Inverted papilloma or fungal sinusitis were differential diagnoses. The histopathological examination revealed a strong infestation by numerous fungal structures with sporangia shape full of sporangiospores. The microorganisms were positive for colorations of Grocott, PAS and Mayer's Mucicarmin; opposite from Coccidioides immitis, which presents no contrast by the mucicarmin. We didn't choose complimentary treatment and after one year of follow-up he presents with no sign of recurrence. Final Comments: Rhinosporidiosis must be considered to be a nasal polypoid lesion differential diagnosis. In the intranasal lesions diagnosis we should keep in mind the patient's origin. The anatomopathological study is mandatory to set the diagnosis. In the rhinosporidiosis, the surgical exeresis can be a curative treatment.

Polymorphic ecthymatoid dermosporidiosis.

We report the case of a young Chhattisgarhi male with polymorphic dermosporidiosis (cutaneous rhinosporidiosis). He had multiple subcutaneous nodules and an ecthymatoid skin lesion along with nasal rhinosporidiosis. The diagnosis was confirmed by demonstration of sporangia with endospores in fine-needle aspiration cytology (FNAC), histopathology, and imprint smear from the skin lesions. Treatment was by surgical excision, electrocoagulation, and dapsone. There was no recurrence. Dermatologists should be aware of the diverse cutaneous manifestations of this primarily nasal disease. This is the second published report of polymorphic dermosporidiosis, and the first one reporting an ecthymatoid lesion.