Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidium seeberi. Rhinosporidium seeberi causes granulomatous inflammation of mucocutaneous sites, presenting most frequently as polypoidal lesions in the nose. Sites like the conjunctiva, trachea, nasopharnyx, skin, and genitourinary tract are less frequently involved. Primary cutaneous lesion is extremely rare and it is often mistaken for soft-tissue tumour. We present a case of 55 years male patient from Thanjavur, Tamilnadu, with primary cutaneous rhinosporidiosis without mucosal involvement

Karthikeyan, G

Prabakar, A

Syed, R

English

Atharva Scientific Publications (E-Jounals)

Prabakar et al                                                                                                                                Rhinosporidioma 
Vol 2 Issue 2 Apr – Jun 2016                                                           Indian J Case Reports / 27 
Case Report 
Rhinosporidioma: Primary Cutaneous Rhinosporidiosis - A Rare Case 
Report  
A Prabakar, G Karthikeyan, R Syed 
From Department of General Surgery, Thanjavur Medical College, Thanjavur, Tamil Nadu, India 
Correspondence to:  Dr A Prabakar, Department of General Surgery, Thanjavur Medical College, Thanjavur , Tamil Nadu, India. 
E mail: dr.a.prabakar@gmail.com. 
Received: 13 February 2016      Initial Review: 09 March 2016          Accepted: 17 April 2016         Published online: 27 April 2016 
ABSTRACT 
Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidium seeberi. Rhinosporidium seeberi causes 
granulomatous inflammation of mucocutaneous sites, presenting most frequently as polypoidal lesions in the nose. Sites like 
the conjunctiva, trachea, nasopharnyx, skin, and genitourinary tract are less frequently involved. Primary cutaneous lesion is 
extremely rare and it is often mistaken for soft-tissue tumour. We present a case of 55 years male patient from Thanjavur, 
Tamilnadu, with primary cutaneous rhinosporidiosis without mucosal involvement. 
Keywords: Cutaneous rhinosporidiosis, Rhinosporidioma, Rhinosporidiosis 
 
hinosporidiosis is a chronic granulomatous 
infection caused by Rhinosporidium seeberi. It is 
endemic in India and in Sri Lanka but has also 
been reported from United States, South America and Iran 
[1]. In India, the disease is endemic in Tamilnadu, Kerala, 
parts of Orissa and eastern Madhya Pradesh. Infection is 
usually caused by contact with fresh water such as 
swimming pools. Rhinosporidiosis frequently involves the 
nasopharynx (70%) presenting as painless, friable, 
polypoidal growth which may hang anteriorly into the 
nares and posteriorly into the pharynx. The cutaneous 
lesions without mucosal involvement are extremely rare 
and they present as asymptomatic soft tissue growth or 
warty growth [1-2]. We report this rare case of primary 
cutaneous rhinosporidiosis without mucosal involvement. 
CASE REPORT 
A 55 years male patient was admitted to our institution, 
with multiple swellings all over the body of 4 years  
 
duration. The initial lesion appeared in the right thigh; 
followed by in right knee, right leg and left leg. There was 
also multiple small swelling all over the body of recent 
onset within 4 months duration. These swellings were not 
associated with pain, bleeding, ulceration or discharge. 
There was gradual increase in the size of the swellings. He 
did not have any difficulty in walking or any sensory 
deficit. 
The systemic examination of the patient was normal. 
Amongst various swellings, there was 7x4 cm swelling in 
the right thigh in lower one-third in the anterior aspect, 7x3 
cm swelling in right anteromedial aspect of upper one third 
of leg, 3x4 cm swelling in right knee and 6x3 cm swelling 
in left leg (Fig 1). These were all soft to firm in 
consistency, non-tender, non-compressible, mobile lesions 
with smooth surface. Similar swellings of varying size and 
swellings were noted in lower limbs, abdomen and back of 
the trunk. Clinical diagnosis of multiple lipoma was made. 
R 
Prabakar et al                                                                                                                                Rhinosporidioma 
Vol 2 Issue 2 Apr – Jun 2016                                                           Indian J Case Reports / 28 
     
Figures: Fig 1 - Multiple subcutaneous lesions in both lower limbs. Fig 2 - MRI scans of lower limb showing lesion in the 
subcutaneous plane. Fig 3 - Cut section of the specimen  
On investigation, haematological and biochemical 
examinations were normal. Chest X-ray and Ultrasound 
abdomen were normal. MRI of both lower limbs were 
done, which showed subcutaneous swelling without 
penetrating the underlying muscle or bone (Fig 2). Fine 
needle aspiration cytology was done which was reported as 
adipocytes with spindle cells and multinucleated giant 
cells, with few adipocytes showing degenerative changes 
in a hemorrhagic background. Excision biopsy was 
planned to confirm the diagnosis. An excisional biopsy of 
the swellings in right thigh, right knee, right leg and left 
leg was carried with a rim of normal skin around (Fig 3).  
Histopathological examination sections showed 
multiple round to oval structures – sporangiaphores of 
different sizes with different stages of maturation, the 
laminated bodies and mature endospores with surrounding 
inflammatory cellular infiltrates. Sporangiophores were 
also seen bursting out through the endospores with smaller 
sporangia in large numbers. These findings were 
suggestive of rhinosporidiosis. PAS staining was done to 
confirm the diagnosis which revealed thick walled 
laminated bodies, released from mature endospores and 
then go on to give rise to spherical juvenile sporangia, 
which is in large numbers. There were immature and 
mature sporangia (Fig 4 & 5). A diagnosis of cutaneous 
rhinosporidiosis was made.  
Patient was subjected to ENT examination to rule out 
mucosal lesion which was normal. CT brain was done to 
rule out disseminated rhinosporidiosis and was found to be 
normal. He did not give any previous history suggestive of 
mucocutaneous or nasopharyngeal rhinosporidiosis. 
Hence, a diagnosis of primary cutaneous rhinosporidiosis 
was made. Following surgical excision, the patient was put 
on dapsone 100 mg twice daily and is on regular follow 
up. Patient is recovering well and no more swelling 
appeared in the follow up period of 3 months. 
 
Fig 4 - HPE showing rhinosporidiosis 
 
Fig 5 - HPE showing rhinosporidiosis  
DISCUSSION
 
Rhinosporidiosis is a chronic recurrent granulomatous 
disease of man and animals, caused by fungus 
Prabakar et al                                                                                                                                Rhinosporidioma 
Vol 2 Issue 2 Apr – Jun 2016                                                           Indian J Case Reports / 29 
Rhinosporidium Seeberi. The organism has not been 
cultured nor has it been successfully transmitted to 
experimental animals [3]. The infection affects nasal 
mucosa, ocular conjunctiva of human and animals 
producing slowly growing masses with pink to purple, 
friable polyps. Disease can manifest in four forms i.e. 
nasal, ocular, cutaneous and disseminated. Infection of 
nose and nasopharynx is observed in majority, while 
infection of the palpebral conjunctiva or associated 
structures like the lacrimal apparatus is observed in 15%. 
Cutaneous lesions are infrequent and are generally 
associated with mucosal lesions. 
Cutaneous Rhinosporidiosis was initially described by 
Forsyth in 1924. Cutaneous lesions can occur due to 
autoinoculation or due to hematogenous spread and are 
described to be of three types: 1) Satellite lesions around 
the nasal polypoidal lesions 2) Disseminated lesions with 
visceral involvement and 3) Primary cutaneous lesions 
without internal organ involvement. Although primary 
cutaneous lesions appear to be uncommon, most authors 
have reported lesions that begin as tiny papules, which 
eventually developed into warty polypoidal growths. 
Poricha et al. described a male patient of rhinosporidiosis 
with multiple, mobile, subcutaneous nodules that 
suppurated and burst with the drainage of mucopurulent 
content leading to ulceration [4]. Other authors have 
described similar presentations either in the presence or 
absence of nasal involvement. 
Date et al. described large lesions on the right thigh in 
a patient from Orissa and subsequently proposed the term 
"rhinosporidioma" [5]. Angunwala et al also described 
similar case of 44-year old male patient from Sri Lanka 
with large masses on thigh and anterior chest wall [6]. In 
above mentioned patients, the clinical appearance had led 
to the diagnosis of chondrosarcoma and soft-tissue 
sarcoma with biopsy showing the typical picture of 
rhinosporidiosis. Our patient with multiple tumor-like 
swellings was a unique presentation of primary cutaneous 
rhinosporidiomas.  
Rhinosporidiosis remains a therapeutic challenge 
amenable only to surgical excision with a high risk of 
recurrence and occasional widespread and fatal 
complications. A number of previous studies using various 
drugs like dapsone, ketoconazole, ciprofloxacin and 
amphotericin B suggested encouraging results only with 
dapsone. Previous light and electron microscopic studies 
have confirmed maturation arrest of spores and accelerated 
granulomatous response with fibrosis following the 
dapsone therapy [7]. Surgical removal and 
electrodesiccation are the treatments of choice [8]. Our 
patient has undergone surgical excision of all significant 
lesions and has been advised to take dapsone for one year. 
CONCLUSION 
The present case is being reported to highlight this rare 
presentation of primary cutaneous rhinosporidiosis that can 
masquerade as soft-tissue tumors. So, we should always 
consider the possibility of cutaneous rhinosporidiosis 
whenever we encounter patients with subcutaneous 
swellings especially in endemic areas. 
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3. https://en.wikipedia.org/w/index.php?title=Rhinosporidium
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4. Porichha O, Pradhan SC, Agarwal MN. Cutaneous 
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5. Date A, Ramkrishna B, Lee VN, Sundraraj GD. Tumoral 
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6. Anjunwala P, Teissera DA, Dissanaike AS. 
Rhinosporidiosis presenting with two soft tissue tumors 
followed by dissemination. Pathology. 1999; 31: 57-8. 
7. Job A, Venkateswaran S, Mathan M, Krishnaswami H, 
Raman R. Medical therapy of rhinosporidiosis with 
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How to cite this article: Prabakar A, karthikeyan G, Syed 
R. Rhinosporidioma: Primary Cutaneous Rhinosporidiosis - 
A Rare Case Report. Indian J Case Reports. 2016; 2(2): 27-
29. 
Conflict of interest: None stated, Funding: Nil 


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