Rhinosporidiosis, is a chronic granulomatous disease caused by Rhinosporidium seeberi presenting as a polypoidal mass in the nasal cavity and nasopharynx and is endemic in Southern India and Sri Lanka. Diagnosis is mainly by clinical observations and is confirmed by histopathology. This is case report of atypical rhinosporidiosis that presented as an Naso-oropharyngeal mass. Hence possibility of this atypical rhinosporidiosis should be included in the clinical differential diagnosis of any posterior oral or oropharyngeal mass, particularly when managing patients from rural endemic areas.

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Rhinosporidiosis presenting as an oropharyngeal mass

Rhinosporidum seeberi is the etiologic agent of rhinosporidiosis, a disease of mucous membranes and infrequent of the skin and other tissues of humans and animals. Because it resists culture, for more than 100 years true taxonomic identity of R. seeberi has been controversial. Three hypotheses in a long list of related views have been recently introduced: 1) a prokaryote cyanobacterium in the genus Microcystis is the etiologic agent of rhinosporidiosis, 2) R. seeberi is a eukaryote pathogen in the Mesomycetozoa and 3) R. seeberi is a fungus. The reviewed literature on the electron microscopic, the histopathological and more recently the data from several molecular studies strongly support the view that R. seeberi is a eukaryote pathogen, but not a fungus. The suggested morphological resemblance of R. seeberi with the genera Microcystis (bacteria), Synchytrium and Colletotrichum (fungi) by different teams is merely hypothetical and lacked the scientific rigor needed to validate the proposed systems. A fundamental aspect against the prokaryote theory is the presence of nuclei reported by numerous authors and updated in this review. Moreover, Microcystis's and Synchytrium's ultra-structural and key cell cycle traits cannot be found in R. seeberi parasitic phase. The PCR amplification of a cyanobacteria 16S rDNA sequence from cases of rhinosporidiosis, while intriguing, will be viewed here as an anomaly due to contamination with environmental Microcystis or perhaps as an endosymbiotic acquisition of plastids from cyanobacteria ancestors. Thus, even if R. seeberi possesses prokaryote DNA, this does not prove that R. seeberi is a cyanobacterium. The placement of R. seeberi within the fungi is scientifically untenable. The isolation and the DNA analysis performed in a fungal strain, and the lack of appropriate controls are the main problems of this claim. Further studies are needed to validate R. seeberi's acquisition of prokaryote plastids and other issues that still need careful scrutiny.

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The taxonomy and phylogenetics of the human and animal pathogen Rhinosporidium seeberi : A critical review

Rhinosporidiosis is a chronic granulomatous disorder of infective etiology previously thought to be caused by Rhinosporidium seeberi but now a cynobacterium, Microcystis aeruginosa has been proposed as a causative agent. The disease is endemic in India and Sri Lanka. Sporadic cases have also been reported from United States, South America, Italy, Iran, and Turkey. Most common site of involvement is nasal mucosa and nasopharynx (70– 75%), other common mucosal site involved is ocular (15%). There have been case reports of involvement of larynx, lips, palate, uvula, trachea, bronchus, ear, vulva, vagina, penis, rectum, and bone. 5,6 Skin involvement is very rare.

Disseminated cutaneous, laryngeal, nasopharyngeal, and recurrent obstructive nasal rhinosporidiosis in an immunocompetent adult: a case report and review of literature

Objective: We report an extremely rare case of rhinosporidiosis with involvement of both larynx and trachea, together with coexisting nasal, nasopharyngeal and oropharyngeal lesions, in a 32-year-old man. Method: Case report and review of the world literature concerning laryngotracheal and disseminated rhinosporidiosis. Results: 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. Fibre-optic laryngoscopic examination revealed reddish masses with whitish surface specks, involving the glottis, subglottis and trachea. Computed tomography revealed soft tissue opacities involving both nasal cavities and the nasopharynx and extending to the oropharynx, with involvement of the larynx and trachea. Direct laryngoscopy and rigid bronchoscopy guided excision of the laryngeal and tracheal lesions was performed. Conclusion: Rhinosporidiosis is a chronic, granulomatous disease which usually affects the mucous membranes of the nose and nasopharynx. Lower dissemination into the trachea is extremely rare. Laryngotracheal involvement poses many diagnostic and therapeutic challenges, due to the potential risk of bleeding and aspiration. In the presented case, local spread of rhinosporidiosis, due to direct spillage of spores from the nasopharynx into the larynx during episodes of bleeding or previous surgery, may have resulted in laryngotracheal involvement, although systemic spread cannot be excluded.

Rhinosporidiosis of the upper airways and trachea.

INTRODUCTION: Rhinosporidiosis is a chronic infection of the mucous membrane and is caused by Rhinosporidium seeberi, an aquatic mesomycetozoan. The mode of infection is probably transepithelial penetration. The large number of rivers and lakes and the strong presence of riparian populations in the State of Maranhao are strong predisposing factors for rhinosporidiosis. METHODS: A 5-year retrospective study was conducted in a tertiary medical center situated in Maranhao, Northeast Brazil. Twenty-five Maranhense patients diagnosed with rhinosporidiosis were analyzed. RESULTS: Most of the patients were children, adolescents and young adults (age range: 7-24 years, mean age: 14 years). The majority of the participants were male (84%), brown (76%), and students (92%). All lesions involved the entire nasal cavity and presented with a vascular polypoid mass. All patients were treated by surgical excision of the lesions. CONCLUSIONS: Rhinosporidiosis affects younger age groups, especially students from the countryside and the outskirts of urban areas. This study will aid and guide physicians in diagnosing and treating this infection in endemic areas.

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Citations

Rhinosporidiosis presenting as an oropharyngeal mass

References

The taxonomy and phylogenetics of the human and animal pathogen Rhinosporidium seeberi : A critical review

Disseminated cutaneous, laryngeal, nasopharyngeal, and recurrent obstructive nasal rhinosporidiosis in an immunocompetent adult: a case report and review of literature

Rhinosporidiosis of the upper airways and trachea.

Rhinosporidiosis: the largest case series in Brazil

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