Question

Rhinosporidiosis.

Hint:

Rhinosporidiosis should be considered in patients presenting with nasal polyps, especially in endemic areas.

Answer 1

Step 1: Overview of Rhinosporidiosis.
Rhinosporidiosis is a rare, chronic, granulomatous infection caused by the water-borne organism Rhinosporidium seeberi. It typically affects the mucous membranes of the nasal cavity, but can also involve other sites like the conjunctiva, oropharynx, and skin.
Step 2: Mode of Transmission.
Rhinosporidiosis is believed to be contracted through the contact with contaminated water or dust, although the exact mode of transmission is not well understood. It is more common in tropical and subtropical regions.
Step 3: Clinical Presentation.
The clinical presentation of rhinosporidiosis is typically characterized by:
(1) Nasal Lesions: Most commonly, patients present with polyploidal, friable masses in the nasal cavity, often causing nasal obstruction, epistaxis (nosebleeds), and discharge.
(2) Conjunctival Involvement: In some cases, conjunctival masses can develop, causing redness, irritation, and discharge.
(3) Aural and Oropharyngeal Involvement: Less commonly, the infection can affect the ears or mouth, leading to similar growths.
Step 4: Diagnosis.
The diagnosis of rhinosporidiosis is usually confirmed by biopsy of the lesion. Microscopically, the organism shows spherical structures containing spores. Special staining techniques, such as periodic acid-Schiff (PAS) or Giemsa stain, help visualize the spore-producing structures.
Step 5: Treatment.
Treatment typically involves surgical excision of the lesions. Because of its chronic nature, recurrence is common. In some cases, dapsone (an antimicrobial agent) is used as adjunctive therapy to prevent recurrence.