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|Year : 1978 | Volume
| Issue : 4 | Page : 235-236
Rhinosporidial infection of the forehead -(report of a case)
M Madhavan, C Ratnakar, KS Mehdiratta
Departments of Pathology and Surgery, Jawaharlal institute of Postgraduate Medical Education and Research, Pondicherry 6., India
Departments of Pathology and Surgery, Jawaharlal institute of Postgraduate Medical Education and Research, Pondicherry 6.
A cystic swelling over the right frontal bone above the medial half of the eyebrow in a 37 year old male was found to be caused by Rhinosporidium seeberi. The patient did not have any past or concurrent lesion which could be presumed to be due to Rhinosporidiosis. The lesion was subcutaneous with overlying healthy skin and had caused erosion of underlying bone.
|How to cite this article:|
Madhavan M, Ratnakar C, Mehdiratta K S. Rhinosporidial infection of the forehead -(report of a case). J Postgrad Med 1978;24:235-6
| :: Introduction|| |
Rhinosporidiosis is known to be common chronic granulomatous lesion affecting the nose and conjuctivae. Lesions of unusual sites are succinctly summarised by Karunaratne in his exhaustive monograph.  Infections of the skin and subcutaneous tissue without any nasal or conjunctival lesion ,,, have evoked interest among workers in this field regarding the life cycle and mode of infection of this parasite. Three cases of isolated lesions of parotid duct also are on record. ,, Here we report another interesting case which was diagnosed by histology alone.
| :: Case report|| |
A 37 year old male came to the hospital for a swelling over the right side of the forehead for 1 year. It had slowly increased in size for the past 9 months. There was no pain over the swelling or fever. Another recent swelling was present over the right lachrymal sac which was diagnosed as acute dacryocystitis. There was no past history suggestive of tuberculosis, syphilis or diabetes mellitus. At no time did the patient suffer from nasal polypoidal lesions.
On examination, the general health of the patient appeared to be good. No lymphadenopathy was observed. Local examination revealed an oval swelling 2.5 x 3.5 cms. in size, situated over the right side of the forehead, just above the right eyebrow, over the medial side. No local rise of temperature, tenderness, or pulsation was felt over this swelling. It was not mobile, though the overlying skin was freely mobile. The upper part of the swelling was hard and the lower part was soft and fluctuant. No bruit was heard. A provisional diagnosis of dermoid cyst was made. X-ray examination showed an osteolytic area over right frontal bone, suggestive of bony erosion. Screening of the chest did not show any abnormality. The swelling over the right lachrymal sac subsided with antibiotics and had completely resolved when the patient was discharged.
The swelling over the forehead was curetted with saucerisation and the material was submitted for histology. The entire tissue was blocked into two samples. These slides showed fibrocollagenous tissue with extensive areas of necrosis with foci of granulomatous reaction. The central cavity was lined by the necrotic debris which closely resembled caseous necrosis. Scattered along these zones of caseous necrosis or surrounded by granulomatous reaction, structures resembling sporangia of Rhinosporidium were seen. Many of these represented empty wall of the sporangium without any endospores which had collapsed and appeared distorted. A few contained endospores which stained pale pink with eosin and appeared to be immature. Special stains like Periodic Acid Schiff, Methenamine Silver and Gridley's confirmed these structures to be sporangia of Rhinosporidium See [Figure 1] and [Figure 2] on page 236A. Thus a diagnosis of rhinosporidial infection of the forehead was made. The patient has not returned to the hospital with any further complaint or for check-up for the subsequent 6 months.
| :: Comments|| |
This patient had acute dachryostitis on the same side of the face as the forehead swelling. But this infection subsided after treatment, so that at the time of his .discharge from the hospital, the lachrymal sac region had become normal. This is important also from the point of view of the long duration of the swelling over the frontal bone, i.e., 1 year throughout which period it slowly increased in size. As the dachryocystitis was of very short duration, just before patient sought hospital admission, it does not appear logical that lachrymal sac could have harboured the rhinosporidium. Thus it is found that a subcutaneous swelling over the frontal bone causing erosion of underlying bone could be caused by Rhinosporidium seeberi wihout manifest evidence of the infection anywhere else on the body. Thus we add one more case to those where bone destruction was found to be caused by Rhinosporidium seeberi. ,
| :: Acknowledgement|| |
We wish to thank the Principal,JIPMER, for allowing us to publish these observations.
| :: References|| |
|1.||Atav, N., Goksan. T. and Ural, A.: The first case of Rhinosporidiosis met with in Turkey. Ann. Otol. Rhin. Laryngol., 64: 1270-1272, 1955. |
|2.||Chandra, K., Ratnakar, C., Ramachandran, P. C. and Satya Parkash: Rhinosporidiosis of the Parotid duct. J. Larvngol. & Otol., 85: 1083-1085, 1971. |
|3.||Cheriyan, P. V. and Satyanarayana, C.: Rhinosporidiosis. Ind. J. Otolaryngol., 1: 15-19, 1949. Quoted by Karunaratne in Ref. No. 5. |
|4.||Dhagayudc, R. G.: Unusual Rhinosporidial infection in man. Ind. Med. Gazette. 76: 513-517, 1941. Quoted by Karunaratne in, Ref. No. 5. |
|5.||Karunaratne, W. A. E.: Rhinosporidiosis in man. The Athlone Press, University of London, 1964. |
|6.||Mahadevan, R.: A rare case of parotid salivary cyst due to rhinosporidiosis. Ind. J. Surg.. 14: 271-274. 1952. |
|7.||Nguyen-Van-Ai; Phan-Ngoc-Duong and Nguyen-Tri-Loc.: Duex cas de rhinosporidiose chez des Viet-Namiens. Bull. Soc. Path. Exot., 51: 314-315, 1958. Quoted by Karunaratne in Ref. No. 5. |
|8.||Purandare, N. M. and Deoras, S. M.: Rhinosporidiosis in Bombay. Ind. J. Med. Sci., 7: 103-110, 1953. |
|9.||Reddi, D. B.: Rhinosporidiosis-A review based on 156 biopsies. Antiseptic, 51: 702711, 1954. Quoted by Karunaratne in Ref. No. 5. |
[Figure 1], [Figure 2]