|Year : 1997 | Volume
| Issue : 5 | Page : 320-322
K Muhammed, K Latheef Abdul
Source of Support: None, Conflict of Interest: None
A 50-year old fisherman presented with multiple polypoid cutaneous and globoid subcutaneous swellings of four years duration. There was history of surgical excision of a nasal polyp in the past. Aspiration cytology and histopathology confirmed the diagnosis of cutaneous and subcutaneous rhinosporidiosis.
Keywords: Rhinosporidiosis, subcutaneous
|How to cite this article:|
Muhammed K, Abdul K L. Subcutaneous rhinosporidiosis. Indian J Dermatol Venereol Leprol 1997;63:320-2
Rhinosporidiosis is a chronic granulomatous disease of man and lower animals, caused by Rhinosporidium seeberi, endemic in South India and Sri Lanka. It is characterised by the development of pedunculated and sessile polypoid lesions on the mucosa of nose, eyes, larynx, penis and rarely on other parts of body like skin. Subcutaneous lesions are extremely rare. We report a case of cutaneous and subcutaneous rhinosporidiosis.
| Case Report|| |
A 50-year-old fisherman who frequently take bath in stagnant water, developed nasal obstruction and polypoid growth in the right nostril four years ago for which polypectomy was done, and was diagnosed to have rhinosporidiosis. About six months after surgery, he developed multiple polypoid sessile masses of varying sizes on eyelids, forehead, scrotum and forearms. Some of these lesions were excised and subjected to histopathological examination and found to be cutaneous rhinosporidiosis. He was treated with dapsone l00mg daily for six months with no response. Then he developed multiple globoid subcutaneous swellings on the upper and lower limbs which gradually increased in size producing lymphoedema on the limbs [Figure - 1]. Aspiration cytology and Histopathological study of biopsy specimen from the subcutaneous swellings confirmed the diagnosis of rhinosporidiosis [Figure - 2]. All the blood investigations including ELISA for HIV and liver function tests were within normal limits. He was given ketoconazole 200mg twice daily for 5 months, but the response was not satisfactory. The subcutaneous swellings have debilitated him and he is not able to do his routine work.
| Discussion|| |
Subcutaneous rhinosporidiosis in our case was diagnosed from tissue aspiration cytology and from histopathological study of biopsy specimen. Aspiration cytology was done by adding a drop of potassium hydroxide (10%) to the aspirated material and microscopic examination of the smear. The presence of sporangia of varying sizes was diagnostic of rhinosporidiosis.
In our case, the previous polypectomy and surgical excision of the cutaneous lesions might have led to the haematological dissemination of the disease, leading to severe disseminated rhinosporidiosis. A case of generalised rhinosporidiosis with visceral involvement was reported by Agarwal et al in 1959. But, the subcutaneous lesions are extremely rare.
Dapsone is usually given for curing or preventing the recurrence in rhinosporidiosis. But in our case, though we have given dapsone for more than 6 months, the response was very poor. We have even tried ketoconazole for nearly 5 months, but the response was not satisfactory.
Though, surgical excision is the treatment of choice recommended in all standard text books, in our opinion, it should be done with caution, as it can lead on to haematological dissemination.
| References|| |
|1.||Agarwal S, Sharma K D, Shrivastava J B, et al. Generalised rhinosporidiosis with visceral involvement: Report of a case. Arch Dermatol 1959;80:22-26. |
|2.||Krishnan K N. Clinical trial of diamino-diphenyl sulphone in nasal and nasopharyngeal rhinosporidiosis. Laryngoscope 1979;89:291-295. |
[Figure - 1], [Figure - 2]