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CASE REPORT
Year : 1990  |  Volume : 56  |  Issue : 1  |  Page : 61-63

Primary cutaneous rhinosporidiosis




Correspondence Address:
N S Hadke


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  Abstract 

Primary cutaneous rhinosporidiosis is very rare and only 10 cases have been reported in India. A 51 year old man had a painless, progressive ulcer for 6 months on the right leg. The ulcer was 2 cm x 2 cm and, had raised, irregular, nodular and partly, undermined margins. Biopsy of the ulcer margin revealed rhinosporidiosis. Excision led to uneventful healing.


Keywords: Rhinosporidiosis, Cutaneous.


How to cite this article:
Hadke N S, Baruah M C. Primary cutaneous rhinosporidiosis. Indian J Dermatol Venereol Leprol 1990;56:61-3

How to cite this URL:
Hadke N S, Baruah M C. Primary cutaneous rhinosporidiosis. Indian J Dermatol Venereol Leprol [serial online] 1990 [cited 2019 Jun 19];56:61-3. Available from: http://www.ijdvl.com/text.asp?1990/56/1/61/3487


Cutaneous rhinosporidiosis is a well-known entity. Majority of the cases described in the literature have a primary lesion inside the nose. Isolated skin involvement is very rare and only 10 instances have been reported till now.[1],[2],[3],[4],[5],[6],[7],[8] We report a further patient having primary cutaneous rhinosporidiosis.


  Case Report Top


A 51-year-old male manual labourer had a progressive painless ulcer on the medial aspect of the right leg of 6 months duration which started as a small nodule and subsequently ulcerated. There was no history of antecedent trauma. The ulcer was solitary and mobile 3 cm above the right medial malleolus. It measured 2 cm x 2 cm and had a raised irregular, crenated and nodular margin [Figure - 1]. There was evidence of healing of a part of the margin, while the rest of the margin was partly under­mined. There was no tenderness, induration or significant regional lymphadenopathy. The leucocyte counts and sedimentation rate were normal. Mantou x test was negative. Chest X-ray was normal. Biopsy from the ulcer margin was reported as rhinosporidiosis [Figure - 2][Figure - 3]. Multiple sections taken from the skin showed focal acanthosis and focal thinning of the epidermis. The dermis showed multiple sporangia, some of them had collapsed, with a thick chitinous wall Many of the sporangi1 contained spores. The dermis showed chroni( inflammatory cell infiltration. PAS and methe namine silver stains confirmed the diagnosis of rhinosporidiosis. Detailed examination of the patient failed to reveal any nasal or ocular lesion suggestive of rhinosporidiosis. Excision of the ulcer with a 0.5 cm margin led to uneventful healing of the wound.


  Comments Top


Rhinosporidiosis is caused by the fungus Rhinosporidiun seeberi. This disease is endemic in India, Sri Lanka, South America, Africa and has been reported sporadically from other parts of the world.[9] In India the disease is endemic in Tamil Nadu and Kerala, parts of Orissa, Eastern Madhya Pradesh and has been sporadi­cally reported from other areas.[10] It predo­minantly involves the nasal mucosa and the adjacent structures like lacrimal sac, conjunctiva, eyelids, palate and uvula. Cutaneous involve­ment in rhinosporidiosis has been described to be of three types : (1) Satellite lesions associated with the nasal lesions, (2) Disseminated lesions associated with visceral involvement, and (3) Primary cutaneous lesions without any other involvement.[11] The last variety is relatively less common. Cutaneous rhinosporidiosis was first described by Forsyth in 1924.[12] Subse­quently, many cases of cutaneous rhinosporidio­sis were reported. However, all these had associated nasal lesions. In such instances, spread of the disease was thought to be due to autoinoculation at the sites iniured by scrat­ching.[9] In two instances, there was widespread involvement of the viscera viz liver, spleen, kidney, heart, lung etc and the infection was thought to be due to haematogenous spread.[13],[14]

Dhayagude reported the first case of primary cutaneous rhinosporidiosis.[l] Subsequently, only 10 cases of primary cutaneous rhinosporidiosis could be found.[1],[2],[3],[4],[5],[6],[7],[8] All these patients had primary cutaneous lesions with no evidence of visceral involvement. In 7 instances there was

only a solitary lesions[2],[3],[4],[5],[7],[8] and in the other 3 there were multiple lesions.[1],[6],[7] The lesions were on the face in 4 instances, [1],[4],[7] the extremities on 4 occasions,[1],[6],[8] scalp in one patient[2] and lip in another.[3] Coutinho reported a patient with an isolated lesion on the abdominal skin.[5]

Nasal infection with rhinosporidiosis is thought to be due to the organisms present in the polluted water or soil entering through the traumatized mucous membrane.[9],[10] However, no organisms have been detected in the water or soil.[9] The disease was found to be common in paddy workers.[9] Others have described it in purely urban populations.[15] Whatsoever may be the primary source of infection, it is not clear why traumatised nasal mucosa is more suscep­tible to infection than skin, which covers a much larger surface area and is more prone to direct trauma in the labourers.

Cutaneous lesions in rhinosporidiosis are usually exuberant and may be confused with malignant ulcers. The lesions begin as tiny papules which later develop into wart-like growths. The surface is usually crenated and as the growths become bigger, some of these ulcerate and develop secondary infection. Only occasionally do they become pedunculated.[9]

The treatment of choice in primary cutaneous rhinosporidiosis is surgical excision including a zone of the surrounding normal skin. The exact width of the normal skin to be excised is arbitrary and long term follow-ups are needed to assess the risk of local recurrence. Dapsone has been tried occasionally and found to yield a good response in both the nasal and the cutaneous lesions.[16],[17],[18]

 
  References Top

1.Dhayagude RG : Unusual rhinosporidial intection in man, Ind Med Gaz, 1941; 76 : 513-515.  Back to cited text no. 1    
2.Cherian PV and Satyanarayana C : Rhinospori­ disosis, Ind J Otolaryngol, 1949; 1 : 15-19.  Back to cited text no. 2    
3.Purandare NM and Dcoras SM : Rhinosporidiosis in Bombay, Ind J Med Sci, 1953; 7 : 103-110.  Back to cited text no. 3    
4.Reddi DB : Rhinosporidiosis (a review based on the study of 156 biopsies). Antiseptic. 1954; 51 702-711.  Back to cited text no. 4    
5.Coutinho EM : Rhinosporidiose: estudo anatomo­patologico de 4 cases, Ann Fac Med Univ Recife, 1955; 15 : 41-46 (Quoted by 9).  Back to cited text no. 5    
6.Sharma KD, Junnarkar RV and Agarwal S Rhinosporidiosis, J Ind Med Assoc, 1962: 38 640-642.  Back to cited text no. 6    
7.Dubey B and Veliath GD : Rhinosporidiosis in Mangalore, J Ind Med Assoc, 1964; 42 : 59-64.  Back to cited text no. 7    
8.Agarwal S : Rhinosporidiosis, J Ind Med Assoc, 1966 ; 46 : 442-447.  Back to cited text no. 8    
9.Karunaratne WAE : Rhinosporidiosis in man, The Athlone Press, London, 1964,  Back to cited text no. 9    
10.Jain SN : Aetiology and incidence of rhinospori­diosis, Ind J Otolaryngol, 1967. 19 : 1-21.  Back to cited text no. 10    
11.Acharya PV, Gupta RL and Darbari VS : Cuta­neous rhinosporidiosis, Ind J Dermatol Venereol, 1973; 39 : 22-25.  Back to cited text no. 11    
12.Forsyth WL : Rhinosporidiunt Kinealyi Lancet. 1924; 1 :951-952.  Back to cited text no. 12    
13.Rajam RV; Viswanathan GS, Rao AR et al Rhinosporidiosis : A study with report of a fatal case of systemic dissemination, Ind Surg, 1955; 17 : 269-298.  Back to cited text no. 13    
14.Agarwal S, Sharma KD and Shrivastava JB Generalised rhinosporidiosis with visceral involve­ment, Arch Dermatol, 1959; 80 : 22-26.  Back to cited text no. 14    
15.Grover S : Rhinosporidiosis, J Ind Med Assoc, 1975 ; 64 : 93-95.  Back to cited text no. 15    
16.Nair KK : Clinical trial of diaminodiphenylsul­phone (DDS) in nasal and nasopharyngeal rhino­sporidiosis, Laryngoscope, 1979; 89 : 291-295.  Back to cited text no. 16    
17.Mahakrishnan A, Rajasekaran V and Pandian PI Disseminated cutaneous rhinosporidiosis treated with dapsone, Trop Geog, Med, 1981; 33 : 189-192.  Back to cited text no. 17    
18.PorichaD, Pradhan SC and Agrawal MN : Cuta­neous rhinosporidiosis in a patient with lepro­matous leprosy, Ind J Leprol, 1985;; 58 : 626-627.  Back to cited text no. 18    


    Figures

[Figure - 1], [Figure - 2], [Figure - 3]

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