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]
CONCLUSION: An effective treatment for R. seeberi-a eukaryote belonging to the class Mesomycetozoea-is still elusive. Copyright 2016. Published by Elsevier Ltd. [ncbi.nlm.nih.gov]
[…] is not so effective but treatment with a year-long course of dapsone has been reported Disease endemic in Chhattisgarh South India, Sri Lanka, South America and Africa. [en.wikipedia.org]
The patient was counselled for ray amputation and prognosis discussed at length. A racket shaped incision was made and wide margin excision was carried out. [ijoonline.com]
Prognosis is excellent, but recurrence is not unusual Keywords Computed tomography scan, lacrimal sac, Rhinosporidium seeberi, rhinosporidiosis Introduction Rhinosporidiosis is a chronic granulomatous disease affecting the mucous membrane primarily. [parjournal.net]
There are no antifungals or antimicrobials that interfere with the prognosis, but we suggest the prolonged use of Dapsone (100 mg/day for several months) may help prevent the disease recurrences (1,2,4). [arquivosdeorl.org.br]
[…] revealed no retinal abnormalities unlike in previous cases reported from Sri Lanka; c) atypical histopathology that resulted in an initial mis-diagnosis of chronic inflammation with mucus cysts and a missed diagnosis of rhinosporidiosis; the rhinosporidial etiology [dovepress.com]
Abstract Rhinosporidiosis is a chronic granulomatous disorder of infective etiology and it frequently affects the nasal cavity and nasopharynx. [e-ijd.org]
Causes: The etiologic agent of rhinosporidiosis, R seeberi, has traditionally been considered a fungus. [easymbbs.org]
DIAGNOSIS: Conjunctival Rhinosporidiosis DISCUSSION Etiology Rhinosporidiosis is an infection caused by Rhinosporidium seeberi. [webeye.ophth.uiowa.edu]
Abstract One hundred forty-three cases of rhinosporidiosis, confirmed by smear or biopsy, treated in two major General Hospitals in Sri Lanka over a 14 year period (1995-2009) were analyzed in regard to their epidemiological, clinical, clinicopathological [ncbi.nlm.nih.gov]
Socio-demographic Correlates of Rhinosporidiosis: A Hospital-Based Epidemiologic Study in Purulia, India. Indian J Otolaryngol Head Neck Surg. 2017 Mar. 69 (1):108-112. [Medline]. [emedicine.com]
The epidemiological features, clinical presentations and histopathology were similar to those in other series. The antirhinosporidial antibody (mean) titers were IgM--142.1 and IgG--178.5, compatible with rhinosporidiosis of long duration. [scienceopen.com]
Comprehensive Approach to Infections in Dermatology is a guide to all types of skin infection, with detailed information on epidemiology, presentation, diagnosis and management. [books.google.de]
Pathophysiology: Rhinosporidiosis is a granulomatous disease affecting the mucous membrane of nasopharynx, oropharynx, conjunctiva, rectum and external genitalia. [easymbbs.org]
Pathophysiology Local infection from exposure to the organism appears to be implicated in the pathogenesis of R. seeberi, but thus far, it has not been possible to intentionally infect an animal model (2). [webeye.ophth.uiowa.edu]
Pathophysiology Rhinosporidiosis is caused by the organism R. seeberi. The taxonomy of this agent has always been controversial. Early researchers noticed similarities between rhinosporidiosis and some aquatic parasites. [dermatologyadvisor.com]
[…] demonstrating the difficulties that arise when working with pathogens that cannot be maintained in the laboratory setting. [18, 19] Other molecular work has demonstrated evidence that R seeberi may have host-specific strains (eg, human vs dog vs swan).  Pathophysiology [emedicine.com]
The site of the excised mass should be cauterized to prevent recurrence. [ncbi.nlm.nih.gov]
Team of surgeons is often required as in present case with appropriate antimicrobial drugs to prevent recurrence. The Author would like to thank the patient for providing consent to use his photograph in this article. 1. [ijoonline.com]
Many a times, surgical ablation or amputation of the involved area of the limb is carried out to prevent recurrences. [casereports.bmj.com]
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