Naso-Bronchial Rhinosporidiosis

Abstract

Rhinosporidiosis is a chronic mucocutaneous granulomatous disease caused by Rhinosporidium seeberi, commonly affecting the nose and nasopharynx. Endobronchial involvement is of rare occurrence but can pose challenging problems for diagnosis, surgical excision and anaesthetic management. We report a 40-year-old man with a history of recurrent nasal rhinosporidiosis who presented with unilateral nasal obstruction, cough, shortness of breath and a radiological feature of left lung collapse. Eight years since the last surgery, he presented with a recurrent lesion in the nose with concurrent endobronchial involvement. The patient underwent excision of the nasal and the endobronchial lesion successfully under general anaesthesia without any complication and good symptomatic improvement. The clinical presentation and the management of endobronchial rhinosporidiosis are discussed here. The surgical difficulties faced during the procedure are highlighted.

Keywords: ear; nasal polyps; nose and throat/otolaryngology; respiratory medicine; tropical medicine (infectious disease).

Figure 1

(A) Contrast CT of nose and paranasal sinuses coronal view, showing heterogeneously enhancing soft tissue density in right nasal cavity, (B) contrast CT axial view showing the involvement of only the right nasal cavity with no extension into paranasal sinuses, (C) clinical picture showing a red, polypoidal vascular mass with white spots on the surface (arrow) filling the entire right nasal.

Figure 2

(A) High resolution CT of thorax, axial view showing a polypoidal mass partially occluding the left main bronchus with left lung collapse, (B) bronchoscopy picture showing red, polypoidal mass filling the left main bronchus, (C) left main bronchus following the removal of the mass.

Figure 3

(A) Preoperative chest X-ray showing collapsed left lung, (B) postoperative X-ray on day 5 showing expanded left lung.

Figure 4

(A) (H&E×40) section shows excessive inflammatory infiltrates with sporangia at various stages, (B) (H&E×200)section shows mature sporangia with numerous spores contained within them.