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THROUGH THE LENS
Year : 2014  |  Volume : 5  |  Issue : 6  |  Page : 125-127  

Strawberry-shaped lesion on the chest: cutaneous rhinosporidiosis


1 Consultant Dermatologist, Alshifa Hospital, Perinthalmanna, Kerala, India
2 Surgeon, Alshifa Hospital, Perinthalmanna, Kerala, India
3 Pathologist, Alshifa Hospital, Perinthalmanna, Kerala, India

Date of Web Publication5-Dec-2014

Correspondence Address:
Dr. K T Ashique
Karalikkattil House, Karakkaparamba, Vaniyambalam Post, Malappuram Dt - 679 339, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5178.146191

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   Abstract 

Rhinosporidiosis is a chronic granulomatous condition caused by the pathogen Rhinosporidium seeberi which frequently involves the nasopharynx and occasionally affects the skin. The disease has been reported from across the globe but the highest incidence has been from south India and Sri Lanka. This disease is commonly seen in adult men and the possible mode of transmission to humans is thought to be by direct contact with spores through dust, infected clothing, fingers, and swimming in stagnant water. The classical presentation is mucosal and here we present a case which presented as a growth on the chest wall. And we stress the need to keep a high index of suspicion in such cases in endemic areas

Keywords: Cutaneous rhinosporidiosis, disseminated rhinosporidiosis, strawberry lesions


How to cite this article:
Ashique K T, Sajid M, Anjit U. Strawberry-shaped lesion on the chest: cutaneous rhinosporidiosis. Indian Dermatol Online J 2014;5, Suppl S2:125-7

How to cite this URL:
Ashique K T, Sajid M, Anjit U. Strawberry-shaped lesion on the chest: cutaneous rhinosporidiosis. Indian Dermatol Online J [serial online] 2014 [cited 2019 Aug 22];5, Suppl S2:125-7. Available from: http://www.idoj.in/text.asp?2014/5/6/125/146191


   Case Report Top


A 55-year-old man presented with a mildly painful red lesion on the right side of his chest that was gradually progressive in size over the past 2 months. He had pain at the site due to pressure effect especially when he tried to lie in prone position, which was the reason for seeking medical attention. He was not a diabetic, but was on antiplatelet medications since many years for his cardiac illness. He did not give history of any other constitutional illness except a surgery about a year back, records of which were not available. He did not give any history of bathing in ponds or rivers in the past. The routine blood investigations, chest X-ray, and HIV screening were negative.

We did not find anything abnormal in his general physical examination. Dermatological examination showed an erythematous nodule with a size of about 4 × 3 × 2 cm occupying the right side of his chest in the supramammary area [Figure 1] and [Figure 2]. It was slightly tender to touch and friable in consistency. The lesion did not bleed on touch, was immobile and well attached to the underlying skin. There was no regional lymphadenopathy. The lesion was excised in toto and skin closed with a flap in layers. The tissue on histopathology examinations showed thick-walled sporangia with numerous spores which was pathognomonic of the diagnosis [Figure 3] and [Figure 4].
Figure 1: Strawberry-sized erythematous lesion on the chest

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Figure 2: Closer view of the lesion

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Figure 3: Thick-walled sporangia with numerous spores (H and E), ×100)

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Figure 4: Stratified squamous epithelium with focal ulceration and hemorrhagic area. Cystic space filled with spores of varying maturation and few areas of hemorrhage (H and E, ×400)

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   Discussion Top


Rhinosporidiosis is a chronic granulomatous condition caused by the pathogen Rhinosporidium seeberi. It frequently involves the nasopharynx and occasionally affects the skin. The disease has been reported from about 70 countries with diverse geographical features, although the highest incidence has been from south India and Sri Lanka. This disease is commonly seen in adult men and the possible mode of transmission to humans is thought to be by direct contact with spores through dust, infected clothing, fingers, and swimming in stagnant water. [1],[2],[3]

The classical presentation of the disease is as pedunculated and sessile polypoid lesions on the mucosa of nose, eyes, and larynx; and very rarely on other parts of the body like skin, viscera, and brain. There are mainly three types of lesions that appear on the skin. They are: (1) Satellite lesions around the nose in case of nasal rhinosporidiosis, (2) generalized skin involvement with or without nasal involvement due to hematogenous dissemination, and (3) primary cutaneous type which may occur by direct inoculation of the organism into the skin. [1] Subcutaneous lesions though rare have also been reported. There are primarily three modes of spreads of the lesions viz. autoinoculation, hematogenous, and direct inoculation. [4] Definitive diagnosis of the disease is by histopathology of the excised specimen. [2] However, in the absence of facilities for tissue diagnosis, a simple aspiration cytology and examination of aspirated material under 10% KOH or Papanicolaou smear may be sufficient to find the organism in various stages of maturation. [4] Surgical removal and/or electrodessication remain the gold standard in the treatment of cutaneous rhinosporidiosis. [5] Dapsone is the only drug found to be beneficial in some cases which may act by arresting the maturation of sporangia and accelerating the degenerative changes in them. [1]

We report this case for its rarity of occurrence in this anatomical location and also to stress the need to keep a high index of suspicion when patients present with such lesions in an endemic geographic location such as southern India, even in the absence of mucosal lesions or high risk activity such as swimming in stagnant water, ponds, etc.

 
   References Top

1.
Kumari R, Laxmisha C, Thappa DM. Disseminated cutaneous rhinosporidiosis. Dermatol Online J 2005;11:19.  Back to cited text no. 1
    
2.
Arseculeratne SN. Recent advances in rhinosporidiosis and Rhinosporidium seeberi. Indian J Med Microbiol 2002;20:119-131.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.
Kamal MM, Luley AS, Mundhada SG, Bohhate SK. Rhinosporidiosis. Diagnosis by scrape cytology. Acta Cytol 1995;39:931-5.  Back to cited text no. 3
    
4.
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. 4
[PUBMED]  Medknow Journal  
5.
Kumari R, Nath AK, Rajalakshmi R, Adityan B, Thappa DM. Disseminated cutaneous rhinosporidiosis: Varied morphological appearances on the skin. Indian J Dermatol Venereol Leprol 2009;75:68-71.  Back to cited text no. 5
[PUBMED]  Medknow Journal  


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]


This article has been cited by
1 Rhinosporidiosis: the largest case series in Brazil
Francílio Araújo Almeida,Laisson de Moura Feitoza,Jaqueline Diniz Pinho,George Castro Figueira de Mello,Joyce Santos Lages,Fábio França Silva,Raimunda Ribeiro da Silva,Gyl Eanes Barros Silva
Revista da Sociedade Brasileira de Medicina Tropical. 2016; 49(4): 473
[Pubmed] | [DOI]



 

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