Rhinosporidial infection of the forehead -(report of a case)

Correspondence Address:
M Madhavan
Departments of Pathology and Surgery, Jawaharlal institute of Postgraduate Medical Education and Research, Pondicherry 6.
India

Source of Support: None, Conflict of Interest: None

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PMID: 745153

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.

:: Introduction

:: Case report

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. [1],[7]

:: 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.

Figures

  [Figure 1], [Figure 2]

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