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  .
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  .