Lacrimal sac rhinosporidiosis presented as nasal obstruction symptoms without any ocular manifestations: a case report.

Abstract

Introduction and importance: Rhinosporidiosis is a chronic granulomatous infection due to Rhinosporidium seeberi and it is endemic mainly in South Asian countries such as India and Sri Lanka. Though it commonly involves nasal and nasopharyngeal mucosa, the involvement of the lacrimal sac is rare. Diagnosis can be done by imaging techniques and confirmed on histopathology.

Case presentation: A 22-year-old male presented with left nasal obstruction and an oropharyngeal mass, without any ocular symptoms. Imaging studies by CT scan revealed a mass involving the nasal and nasolacrimal regions. Biopsy confirmed rhinosporidiosis. The patient underwent a wide local excision of the mass with partial resection of the lacrimal sac. Postoperatively, the patient was given Dapsone for 6 months. Regular follow-up with nasal endoscopy and ophthalmology review showed no evidence of recurrence 1 year following surgery.

Clinical discussion: Rhinosporidiosis typically presents as vascular polyps in the nasal or ocular areas. It is uncommon that there might be involvement of the lacrimal sac without any symptomatology relevant to the conjunctiva, which has been elaborated in the present case. Examination for the extent of disease is assisted by techniques such as CT and MRI. Histopathology is confirmatory, showing a typical appearance with sporangia filled with multiple endospores. Treatment can be carried out mainly by surgical excision supplemented by electro-coagulation to avoid recurrence. Dapsone post-operatively is recommended as recurrence is common in rhinosporidiosis.

Conclusion: Although rhinosporidiosis predominantly affects the nasal mucosa, lacrimal sac involvement should be considered in the differential diagnosis. Surgical excision along with postoperative medication and regular follow-up forms the mainstay in the management of the disease to avoid recurrence.