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E-IJD CORRESPONDENCE
Year : 2015  |  Volume : 60  |  Issue : 2  |  Page : 218
Disseminated cutaneous rhinosporidiosis: a polymorphic presentation in an immunocompetent patient


From the Department of Skin and Venereal Diseases, Shrirama Chandra Bhanj Medical College, Cuttack, Odisha, India

Date of Web Publication3-Mar-2015

Correspondence Address:
Bharati Sahu
From the Department of Skin and Venereal Diseases, Shrirama Chandra Bhanj Medical College, Cuttack, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.152596

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How to cite this article:
Sahu B, Sahu P, Puhan MR. Disseminated cutaneous rhinosporidiosis: a polymorphic presentation in an immunocompetent patient. Indian J Dermatol 2015;60:218

How to cite this URL:
Sahu B, Sahu P, Puhan MR. Disseminated cutaneous rhinosporidiosis: a polymorphic presentation in an immunocompetent patient. Indian J Dermatol [serial online] 2015 [cited 2020 Mar 30];60:218. Available from: http://www.e-ijd.org/text.asp?2015/60/2/218/152596


Sir,

A 65-year-old female presented with asymptomatic lumps, two in number on her left antero-lateral thigh of 10 months duration. On examination the larger nodule was of size 16 × 12 cm with a smooth surface, firm to soft in consistency and with dilated veins over it. It was not attached to underlying structures, with minimal signs of inflammation. The smaller nodule (5 × 5 cm) was highly tender, soft in consistency giving a pyogenic granuloma-like appearance at the site of rupture [Figure 1]. There was a history of nasal mass with recurrent epistaxis 6 months back, excised but without any record. The patient used to take bath in pond daily. General physical and systemic examinations were within normal limits. Routine hemogram was within normal limits. Chest X-ray and abdominal ultrasonography were within normal limits. ELISA for HIV was non-reactive. Radiological evaluation revealed a clearly delineated dense radiopaque subcutaneous mass not attached to underlying structures. A biopsy from the lesion showed immature and mature thick-walled sporangia with endospores in highly vascular sub-epithelial stroma and dermis, respectively [Figure 2]. Few sporangia rupturing to release the endospores were also seen [Figure 3].
Figure 1: Two lumps over left antero-lateral thigh

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Figure 2: Immature and mature thick walled sporangia with endospores in highly vascular sub epithelial stroma and dermis (H and E, ×400)

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Figure 3: Sporangia rupturing to release the endospores (H and E, ×1000)

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Diagnosis of disseminated cutaneous rhinosporidiosis along with nasal rhinosporidiosis was made. Lesions were excised with electrocoagulation of the base and dapsone was given to prevent recurrence.

Rhinosporidiosis is a rare chronic granulomatous condition, acquired by contact with stagnant water like ponds and swimming pools. Rhinosporidium seeberi, etiological agent for rhinosporidiosis, was initially classified as a fungus. A portion of the R. seeberi 18S rRNA gene was amplified using PCR which supports its phylogentic relationship with protozoa, now classified as an aquatic protistan of Mesomycetozoea class (Ichthyosporea). [1] It is endemic in Sri Lanka and parts of India. In India Orissa, Chhattisgarh, Tamil Nadu, Kerala, Karnataka, and Pondicherry are endemic states for this disease. Sporadic cases among migrant population are seen. [2],[3] Four common varieties have been described nasal, ocular, cutaneous, and disseminated forms. [4],[5],[6],[7],[8],[9] Cutaneous lesions are very rare, and generally associated with simultaneous or with past history of mucosal lesions.

Three main types of cutaneous rhinosporidiosis and their mode of spread had been reported:

1. Satellite skin lesions surrounding mucosal lesions through autoinoculation.

2. Disseminated skin lesions with or without the nasal involvement through a hematogenous route.

3. Primary cutaneous type through direct inoculation.

Mucosal lesions develop through transepithelial spread. [10],[11] Skin lesions resembling lipomas, verrucous tuberculosis, pyogenic granulomas, viral wart, donovanosis and also subcutaneous nodules have been described. Other rarer forms include those resembling soft tissue tumors, furuncles, ecthyma, and giant cutaneous lesions. Treatment is by excision with electrocoagulation, but recurrences may occur. Oral dapsone might arrest the maturation of the sporangia and cause stromal fibrosis. [12]

Our patient had disseminated cutaneous rhinosporidiosis without any evidence of immunosuppression. She had polymorphic lesions, an asymptomatic subcutaneous giant mass, and a smaller painful pyogenic granuloma like lesion. Only two cases of polymorphic lesions in a single patient had been described earlier. [13] This case is being reported due to rare polymorphic lesions of rhinosporidiosis in an immunocompetent patient.

 
   References Top

1.
Fredricks DN, Jolley JA, Lepp PW, Kosek JC, Relman DA. Rhinosporidium seeberi: A human pathogen from a novel group of aquatic protistan parasites. Emerg Infect Dis 2000;6:273-82.  Back to cited text no. 1
    
2.
Ramanan C. Giant cutaneous rhinosporidiosis. Int J Dermatol 1996;35:441-2.  Back to cited text no. 2
    
3.
Ghorpade A. Rhinosporidiosis: Gigantic cells with engulfed sporangia of Rhinospoirdia seeberi in the case of dermosporidiosis. Int J Dermatol 2008;47:694-5.  Back to cited text no. 3
    
4.
Kumari R, Nath AK, Rajalakshmi R, Adityan B, Thappa DM. Disseminated cutaneous rhinosporidiosis: Varied morphological appearances on the skin. Indian J Dermatol Venerol Leprol 2009;75:68-71.  Back to cited text no. 4
    
5.
Nayak S, Rout TK, Acharjya B, Patra MK. Subcutaneous rhinosporidiosis. Indian J Dermatol 2008;53:41-3.  Back to cited text no. 5
[PUBMED]  Medknow Journal  
6.
Shrivastava A, Bhat D, Parate S, Bobhate SK. Cutaneous Rhinosporidiosis. Indian J Dermatol 1997;42:234-5.  Back to cited text no. 6
  Medknow Journal  
7.
Mandal SK, Dutta S, Roy S. Cutaneous Rhinosporidiosis. Indian J Dermatol 2000;45:78-80.  Back to cited text no. 7
    
8.
Bandyopadhyay D. Cutaneous Rhinosporidiosis. Indian J Dermatol 1997;42:100-1.  Back to cited text no. 8
  Medknow Journal  
9.
Agarwal S, Khullar R, Khare AK. Cutaneous rhinosporidiosis: A case report. Indian J Dermatol 1991;36:88-92.  Back to cited text no. 9
    
10.
Acharya PV, Gupta RL, Darbari BS. Cutaneous rhinosporidiosis. Indian J Dermatol Venereol Leprol 1973;39:22-5.  Back to cited text no. 10
    
11.
Nayak S, Acharjya B, Devi B, Sahoo A, Singh N. Disseminated cutaneous rhinosporidiosis. Indian J Dermatol Venereol Leprol 2007;73:185-7.  Back to cited text no. 11
[PUBMED]  Medknow Journal  
12.
Verma R, Vasudevan B, Pragasam V, Deb P, Langer V, Rajagopalan S. A case of disseminated cutaneous rhinosporidiosis presenting with multiple subcutaneous nodules and a warty growth. Indian J Dermatol Venereol Leprol 2012;78:520.  Back to cited text no. 12
[PUBMED]  Medknow Journal  
13.
Ghorpade A. Polymorphic cutaneous rhinosporidiosis. Eur J Dermatol 2006;16:190-2.  Back to cited text no. 13
    


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  [Figure 1], [Figure 2], [Figure 3]



 

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