Progressive Left Nasal Obstruction and Intermittent Epistaxis

Abstract

A man in his 20s presented to a tertiary rhinology center in southwestern Florida with a 3-month history of progressive left nasal obstruction and intermittent epistaxis. Two years previously, the man had similar presenting symptoms at an outside facility and was treated with surgery to excise a sinonasal mass. He did not have any visual changes, pain, or purulent nasal discharge. He reported no olfactory impairment. He was originally from Bangladesh but had moved to the United States 6 years earlier. In-office flexible fiberoptic nasal endoscopy revealed a soft, friable polypoid mass with a strawberry-like appearance originating from the lateral nasal wall and filling the left nasal cavity (Figure, A). Computed tomography of the sinuses revealed a left nasal cavity mass without bony destruction or paranasal sinus involvement (Figure, B). The patient underwent endoscopic sinus surgery on the left side, where complete surgical excision of the mass was performed along with electrocautery of attachment sites. The mass was found to have multiple attachments surrounding the maxillary sinus ostium and mucosa overlying the lacrimal bone. Pathologic evaluation revealed squamoid-type mucosa with large, thick-walled sporangia with numerous endospores. Also present was an exuberant mixed inflammatory infiltrate consisting of polymorphonuclear leukocytes, plasma cells, and lymphocytes (Figure, B and C).

Case Report: Rhinosporidiosis Literature Review

“…The likelihood of spontaneous regression of nasal polypoidal lesions is unlikely in the natural course of rhinosporidiosis. 28 Characteristically, the surgical removal of the lesion with cautherization of the attachment base is almost curative in at least 90% of the cases, 29 but in endemic areas, recurrence is variable, ranging between 5% and 67%; especially in mucosal sites (oropharynx and paranasal sinuses), apparently related to the difficulty to achieve complete excision 28,30 ; and with disseminated involvement, it reaches 100%. 31 For that reason, some authors raise the question of a systemic compromise in this pathology, suggesting a more detailed laboratory evaluation and aggressive surgical approach at the first assessment and recommending the complementation of the surgical management with pharmacological treatment of probably remaining reservoirs in the body (blood or the lymphatics) that could explain the relapses.…”

Synchronous nasal rhinosporidiosis and inverted papilloma in a paediatric patient in Dodoma, Tanzania: Case report

“…1,12 Surgical removal of the lesion with cauterization of the attachment base is almost curative in at least 90% of the cases. 12,41 Wide local surgical excision may be associated with remarkable morbidity due to hemorrhage and septal perforation and therefore limited surgical excision and adjuvant medical therapies, including antifungals such as griseofluvin and amphotericin B, trimethoprimsulphadiazine, and sodium stibogluconate have been tried with varied success. All drugs are endospore-static rather than endosporicidal.…”