Rhinosporidiosis is a relatively rare, chronic and recurrent granulomatous disease caused by Rhinosporidium seeberi. It typically involves the upper respiratory tract but can affect other parts of the body too and its lesions have a characteristic appearance. Clinical manifestations are variable based on the location of the granulomas and the diagnosis depends on history, identifying the granulomas by their appearance, and imaging studies to delineate extent. The gold standard test for confirmation, however, is the histopathological examination of the lesions in the affected tissue.
Rhinosporidiosis was first reported in Argentina but it is prevalent in many countries  and is endemic to Sri Lanka and parts of India . The condition is caused by Rhinosporidium seeberi which is difficult to isolate or grow in culture media . It is transmitted during swimming in infected waters and enters the human body through mucosal or cutaneous abrasions . It typically affects young male adults, especially divers, farmers and sand workers . Female patients with Rhinosporidiosis are rarely encountered probably because they are less active outdoors in the affected areas .
Patients can present several years after the initial infection as the lesions are slow growing. The granulomas can be identified by their classical appearance - pedunculated or sessile, soft, polypoidal, strawberry shaped masses which can occur on the mucous membrane of the nose, throat, soft palate, nasopharynx, conjunctiva, nasolacrimal duct, lacrimal gland, larynx, rectum  and even genitalia  . The nasal septum and inferior turbinates are the most common sites in the nose to be involved . The oral cavity is rarely affected. Sexual partners of men with rhinosporidiosis of the urethral meatus have not been reported with rhinosporidiosis and therefore it is presumed to be non-contagious. The polypoidal lesions tend to recur despite treatment.
Cutaneous granulomas, as well as disseminated forms of the disease with brain involvement and even fatal cases, have been reported  .
Entire Body System
Soft Tissue Mass
Fiberoptic laryngoscopy revealed a reddish soft tissue mass below the vocal cord level. Magnetic Resonance Imaging showed a soft tissue opacity within the trachea occluding the airway. Direct endoscopic biopsy was done after securing the airway. [ncbi.nlm.nih.gov]
The lesion presents as a soft tissue mass of the nose (primary site), eye and urethra. The organism is difficult to culture and the diagnosis is based on microscopy and histological examination of the lesion. [casereports.in]
CT scan revealed a soft tissue mass in the nasopharynx with the impression of a polyp or a neoplasm. Histological examination revealed variable sized cysts with a chitinous wall consistent with rhinosporidiosis. [pjms.com.pk]
Exposure to Contaminated Water
[…] to contaminated water Increased tearing and photo phobia in cases of infection of palpebral conjunctiva On examination Pink to deep red polyps Strawberry like appearance Bleeds easily upon manipulation Diagnosis confirmed by biopsy and histopathology [en.wikipedia.org]
History of exposure to contaminant water. Increased tearing and photo phobia in cases of infection of palpebral conjunctiva. Headache. Skin lesions begin as papillomas that gradually become verrucous. [easymbbs.org]
A 32-year-old, South Indian man presented with a nasal mass of four years' duration, with progressive hoarseness for one year. Strawberry-like rhinosporidial masses were seen in both nasal cavities. [ncbi.nlm.nih.gov]
The technique was atraumatic and also avoided the potential for autoinoculation, which is a frequent cause of recurrence of this disease.  Madana et al. reported a case of nasal rhinosporidiosis with progressive hoarseness of voice for 1 year. [laryngologyandvoice.org]
We describe a new case, which occurred in a patient with coexisting nasal rhinosporidiosis who presented with inspiratory stridor. Both lesions were completely excised under general anesthesia without the need for preliminary tracheostomy. [ncbi.nlm.nih.gov]
Both were excised under local anesthesia.  In 2004 Kumar et al. described a new case of laryngeal rhinosporidiosis, which occurred in a patient with coexisting nasal rhinosporidiosis who presented with inspiratory stridor. [laryngologyandvoice.org]
It poses diagnostic and therapeutic challenges and has high chance of mortality because of presentation with respiratory distress. We report such a case of a 35 years old man who presented with respiratory distress and dry irritating cough. [ncbi.nlm.nih.gov]
We report such a case of a 35 years old man who presented with respiratory distress and dry irritating cough. Fiberoptic laryngoscopy revealed a reddish soft tissue mass below the vocal cord level. [ncbi.nlm.nih.gov]
Case Report An 8-year-old female presented to our clinic with a history of foreign body sensation, irritation and occasional epiphora in the right eye of 8 months duration. Visual acuity in both eyes was 20/20 N6. [ijo.in]
The workup of rhinosporidiosis involves a detailed history and examination findings of the characteristic polypoidal, strawberry shaped appearance of the friable mass covered with white dots . There are no laboratory tests for diagnosing the condition.
The extent of rhinosporidiosis can be determined using computed tomography (CT) scans which show enhancing lesions of moderate to severe intensity .
Histological examination of the lesions under the microscope is necessary to confirm the diagnosis. Fungal stains like Gomori methenamine silver and periodic acid-Schiff, as well as standard hematoxylin and eosin stains and potassium hydroxide preparations, can help to view the organism in different stages. Aspirates from rhinosporidiosis granuloma can provide cytological evidence while its identity can be confirmed due to the electron dense bodies within its endospores . It is important to differentiate these endospores from those of Coccidioides immitis.
Currently, enzyme-linked immunosorbent assay (ELISA) is not available for routine testing but is used for epidemiological studies  .
It is important to differentiate these endospores from those of Coccidioides immitis. Currently, enzyme-linked immunosorbent assay (ELISA) is not available for routine testing but is used for epidemiological studies. [symptoma.com]
Rhinosporidium seeberi should be distinguished from another microrganism, Coccidioides immitis. [diagnosticpathology.org]
The sporangium of R. seeberi is larger and has thicker walls (diameter of 50-100 mm vs. 20-80 mm) as compared with Coccidioides immitis. [ijoonline.com]
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- Sudasinghe T, Rajapakse RP, Perera NA, Kumarasiri PV, Eriyagama NB, Arseculeratne SN. The regional sero-epidemiology of rhinosporidiosis in Sri Lankan humans and animals. Acta Trop. 2011 Oct-Nov; 120(1-2):72-81.