|Year : 1985 | Volume
| Issue : 4 | Page : 210-1
Tracheal rhinosporidiosis (a case report).
AK Shah, MV Ingle
A K Shah
|How to cite this article:|
Shah A K, Ingle M V. Tracheal rhinosporidiosis (a case report). J Postgrad Med 1985;31:210-1
|How to cite this URL:|
Shah A K, Ingle M V. Tracheal rhinosporidiosis (a case report). J Postgrad Med [serial online] 1985 [cited 2021 Apr 20 ];31:210-1
Available from: https://www.jpgmonline.com/text.asp?1985/31/4/210/5380
Rhinosporidiosis is an infection o mucocutaneous tissue caused by Rhinosporidium seeberi, an as yet unclassified fungus.It is a chronic granulometous disease characterized by the production of large polypoidal lesions that are hyperplastic, highly friable and sessile or pedunculated. As the name suggests, the nose is most commonly affected.The other areas that are found involved are the conjunctive, pharynx, anus, penis, vagina, ears, larynx and skin.Lesions in the tracheo-bronchial tree are rarely reported. This report describes a case of rhinosporidiosis that extended to involve the larynx and trachea.
A 50 year old truck driver from Southern Maharashtra (India) was diagnosed as suffering from nasal rhinosporidiosis in 1973. Between 1973 and 1977 he underwent diathermy excision five times for his nasal and nasopharyngeal sporidiosis. At the time of fifth intervention in January 1977, a rhinosporidial mass, 1 cm in diameter, was noticed on the lingual surface of the epiglottis and a very small mass 0.25 cm in diameter was also observed on the laryngeal surface of the epiglottis. These were cauterized. Six months later, in June 1977 he was admitted with severe dysponea, which was not relieved by tracheostomy. Direct laryngoscopy showed the larynx to be free from disease. Bronchoscopy revealed a large polypoidel mass in the trachea about 2.5 cm proximal to the carina. A soft endotracheal tube was passed by the side of the mass to relieve the dyspnoea. Detailed clinical examination showed no rhinosporidial masses in the nose, nasopharynx or any other organs. Scars due to previous excisions could be seen in the nose and nasopharynx. X-ray of the chest was normal. Ten days following relief of dyspnoea by the endotracheal intubation, anterior mediastinotomy was done with the assistance of the thoracic surgeon. Trachea was opened by a vertical incision. A 2 cm x 1 cm mass was found attached to the left postero-lateral wall of the trachea by a 4-5 mm stalk, 3 cm proximal to the carina. It was snipped off with a diathermy knife and the base was cauterized. The patient made an uneventful recovery. A post-operative bronchoscopy done 4 weeks later showed normal mucosa without any evidence of recurrence or granulation tissue. The patient was asked to follow-up every month. However, he reported to us after 3 months with a history of occasional dyspnoea. On recurrent bronchoscopic examination, approximately 0.5 x 0.25 cm recurrent mass was noted at the same site. Since the recurrence was small, an endoscopic cauterization was planned in stages at weekly intervals. Unfortunately, the patient did not follow-up for any further cauterization, and expired after 6 months.
Treatment of rhinosporidiosis is a problem yet unsolved. Diathermy excision is considered to be the treatment of choice.Recurrences at more than one, sites are common. It is generally felt that external surgery in rhinosporidiosis should be avoided for the fear of implantation.
In the case reported here, inspite of local diathermy excisions, recurrences were noted and new sites were getting involved. Trauma due to intubation during previous excisions done under general anaesthesia and implantation of rhinosporidium, could explain the involvement of trachea. We considered a biopsy or excision through bronchoscope rather dangerous in view of the vascular nature of these lesions. The appearance of the lesion and a positive history of multiple rhinosporidial lesions in the upper respiratory tract were proof enough of the diagnosis. In a case of bronchial rhinosporidiosis reported by Thomas et al,4 a biopsy through bronchoscopy was carried out without much bleeding, followed by a lobectomy as local excision was found to be impossible. We were able to remove the mass totally with cauterization of the base.
Recurrences and repeated diathermy excisions are acceptable when the lesion is restricted to the nose and the nasopharynx. But in cases involving the tracheobronchial tree this is dangerous and probably justifies a more radical approach. Now with lasers available at some centres, the choice of treatment may be cauterization with laser through a bronchoscope. However, lasers are still not freely available where rhinosporidiosis is endemic i.e. India and Ceylon.
The authors wish to thank the Dean, Seth G.S. Medical College and K.E.M. Hospital, Bombay, for allowing to publish the hospital data.
|1||Khan, A. A., Khaleque, K. A. and Huda, M. N.: Rhinosporidiosis of the nose. J. Laryngol. & Otol., 83: 461-473, 1969. |
|2||Emmons, C. D., Binford, C. H., Utz, J. P. and Kwon-Chung, K. J.: Medical Mycology, 3rd edition. Lea and Febiger, Philadelphia, 1977, pp. 464-470.|
|3||Rippon, J. W.: Medical Mycology: The Pathogenic Fungi and Pathogenic Actinomycetes. 1st Edition, W. B. Saunders & Co., Philadelphia, London, Toronto, 1974, pp. 285-294.|
|4||Thomas, T., Gopinath, N. and Betts, R. H.: Rhinosporidiosis of the bronchus, Brit. J. Surg., 44: 316-319, 1956.|
|5||Von Haacke, N. P. and Mugliston, T. A. H.: Rhinosporidiosis. J. Laryngol. & Otol., 96: 743-750, 1982.|