Recurrent Rhinosporidiosis

Abstract

Rhinosporidiosis is a rare, chronic granulomatous disease, caused by the parasite Rhinosporidium seeberi. While rare in the United Sates, the disease is prevalent in the Indian subcontinent; as such, increasing immigration from that region will change the prevalence of R. seeberi in the United States. We report a case of recurrent rhinosporidiosis in a Bangladeshian male affecting the nasopharynx. The patient is a 41-year-old male from Bangladesh, with a 20 pack year smoking history, who first presented to our office, 4 years ago, complaining of hoarseness and a "feeling of a lump" in his throat. His symptoms were progressive. He underwent surgical resection using combination of scapel and electrocautery. Pathology was consistent with rhinosporidiosis. He now presents, 4 years later, with similar complaints and a physical examination demonstrating a recurrent, flesh-like lesion. This time however, surgical excision was performed using the Harmonic TM scapel. Follow-up endoscopic evaluation 6 months after surgery showed no signs of a recurrent lesion. The mode of treatment for rhinosporidosis has widely been anecdotal without much literature. Wide local surgical electrocauterization is the treatment of choice with postoperative systematic dapsone that may be prescribed for up to 1 year. However, local recurrence remains a problem, likely secondary to auto-innoculation during the surgical trauma. Although rare in the United States, immigration from areas of the world where it exists increases the likelihood that the practicing head and neck specialist may encounter such disease entity in their practice. Familiarity with surgical and medical therapy will afford a more systematic approach for treating patients.

Rhinosporidiosis: Various Presentations and Different Sites

“…Patients with thick nasal discharge, history of previous operation, excessive operative bleeding and attachments in the difficult to access areas were the main reasons for recurrences. Use of KTP Laser, 20 Diode Laser, 21 Harmonic scalpel, 22 and coblation 23 has been mentioned in the literature to help minimize bleeding and recurrences.…”

Rhinosporidiosis- A retrospection

“…Laser excision and use of harmonic scalpel has been tried owing to its superior haemostasis and capability of preserving the local integrity of the tissue. 10,15 Coblation, radiofrequency cautery, has been reported to penetrate surrounding tissues to a depth of only 100µm. As the temperature does not exceed 60⁰C in coblation mode, there is less lateral thermal damage as seen with cautery and laser.…”

Recurrent Rhinosporidiosis: Coblation Assisted Surgical Resection—A Novel Approach in Management

“…In a case report of recurrent rhinosporidiosis by Nichlani, in which they excised the lesion using diode laser, they followed up the case for 1 year, in which no recurrence was reported [ 9 ]. In 2014 a case has been reported by J. Chery, C. Bacskai, and E. Mendoza in which they have excised the recurrent rhinosporidiosis with harmonic scalpel, citing the superior hemostasis of the instrument while preserving the local integrity of local tissue [ 10 ]. In a prospective study by surgical excision with electrocautery, can cause localized tissue trauma and in addition expose the unaffected sites to the blood during surgery, which in turn can cause inoculation.…”