|Year : 1990 | Volume
| Issue : 1 | Page : 61-63
Primary cutaneous rhinosporidiosis
NS Hadke, MC Baruah
N S Hadke
Source of Support: None, Conflict of Interest: None
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
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.,,,,,,, We report a further patient having primary cutaneous rhinosporidiosis.
| Case Report|| |
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|| |
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. 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. 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. The last variety is relatively less common. Cutaneous rhinosporidiosis was first described by Forsyth in 1924. 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. 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.,
Dhayagude reported the first case of primary cutaneous rhinosporidiosis.[l] Subsequently, only 10 cases of primary cutaneous rhinosporidiosis could be found.,,,,,,, All these patients had primary cutaneous lesions with no evidence of visceral involvement. In 7 instances there was
only a solitary lesions,,,,, and in the other 3 there were multiple lesions.,, The lesions were on the face in 4 instances, ,, the extremities on 4 occasions,,, scalp in one patient and lip in another. Coutinho reported a patient with an isolated lesion on the abdominal skin.
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., However, no organisms have been detected in the water or soil. The disease was found to be common in paddy workers. Others have described it in purely urban populations. 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.
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.,,
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[Figure - 1], [Figure - 2], [Figure - 3]
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