Tracheobronchial rhinosporidiosis: an uncommon life‐threatening benign cause of airway obstruction

Abstract

Rhinosporidiosis is a chronic granulomatous infectious disease caused by Mesomycetozoea Rhinosporidium seeberi. This highly recurrent polypoid lesion has a predilection for the nose and nasopharynx, although other organ systems may be affected. Involvement of the tracheobronchial tree is very rare, and poses a challenge for diagnosis and management. In this report, we present a 30‐year‐old man with a history of recurrent nasal polyp who presented with cough, shortness of breath, haemoptysis, and a radiological feature of right lung collapse on imaging. He was diagnosed with rhinosporidiosis based on histopathological examination of bronchoscopic biopsy specimen taken from the right principal bronchial mass. Shortly after hospitalization, he developed acute respiratory distress requiring emergency bronchoscopic intervention. A pinkish mulberry‐like tracheal and right bronchial mass was removed endoscopically with cauterization of the base of the lesion. On long‐term follow‐up, the patient was free of symptoms without recurrence of airway disease.

Naso-Bronchial Rhinosporidiosis

“…Biopsy of such lesions must be avoided because of the risk of bleeding, aspiration and further dissemination 2 7. CT imaging of the chest and virtual bronchoscopy may provide better details about the extent of the lesion 1. The preoperative CT chest of our patient showed polypoidal mass occluding the left main bronchus.…”

“…In 1923, Ashworth described the life cycle of an organism, argued it as a fungus, and named it R. seeberi . However, recent phylogenetic analysis suggests a protozoan organism in the newly described class Mesomycetozoea of animal–fungus boundary 1. It is common in the tropics, and its highest prevalence is seen in Southern India and Sri Lanka 2.…”

“…The first case of tracheobronchial rhinosporidiosis was reported in 1956 by BETTS et al 4. A literature search for trachea-bronchial rhinosporidiosis revealed only over 16 cases, including the index case 1 3 5…”

“…Surgical excision is the treatment of choice for rhinosporidial mass, and ablation of the lesion base is strongly recommended, as local recurrence is common due to spillage of sporangia. External surgery should be avoided for fear of local implantation 1 3 6. Various methods have been used in management, including flexible and rigid bronchoscopic snaring, argon plasma coagulation, laser, tracheotomy and surgical excision.…”

Epidemiological, clinical and anatomopathological characterization of nasal rhinosporidiosis in a horse

“…Cases of rhinosporidiosis have been described mainly in horses (Argenta et al, 2018;Tizzano et al, 2021;Zibordi et al, 2020), humans (Ghosh et al, 2021;Sarkar et al, 2020;Tiwari et al, 2015), and sporadically in cattle (Riet-Correa et al, 1983), mules (Berrocal & López, 2007), canines (Borrás et al, 2020;Borteiro et al, 2018;Cridge et al, 2021), cats (Brenseke & Saunders, 2010;Moisan & Baker, 2001) and waterfowl (Kennedy et al, 1995). Lesions are characterized by polypoid, granulomatous, friable and painless nodules, which can occur in the nasal cavity, larynx, ocular conjunctiva, skin, oral mucosa, genitalia, lips and ears (Tiwari et al, 2015).…”