Nasal Rhinosporidiosis with septal perforation a unique case report


Dr. T. Balasubramanian M.S. D.L.O.

Synonyms:  Nasal rhinosporidiosis with septal perforation

Case Report:
     30 Years old male patient came to me with h/o

1. Bleeding from both nasal cavities on and off for 10 years

2. Blocking sensation in left nasal cavity for 10 years

3.  Headache on and off on the left side - 7 years

4. Foul smelling nasal discharge from left nose - 5 years

He also gave history of taking bath in ponds.

On examination:  Left nasal cavity was found filled with a friable leaf like mass.  Mass was found occupying the floor of the left nasal cavity extending up to the choana.  Mass was seen protruding out of choana into the nasopharynx.  The mass was friable and started to bleed on touch.  A perforation was seen on the cartilagenous portion of the nasal septum through which the mass extended in to the right nasal cavity.  
     Clinically the mass resembled a rhinosporidial mass. 

CT scan taken showed:

This coronal Scan shows perforation in the anterior cartilagenous portion of nasal septum

This coronal scan shows mass passing through the eroded septum

Discussion:  Till date no case of nasal rhinosporidiosis has been reported with septal perforation.  In this patient the cartilagenous portion of the septum was found to be eroded.  In fact it is the cartilage which is supposed to be more resisitant to tumor invasion. 

The possible causes of septal erosion in this patient could be:

1.  Rhinosporidial mass causing repeated infection of the perichondrium of nasal septal cartilage leading on to chronic perichondritis and septal erosion.

2. Pressure effects of the mass - (Not acceptable taking into consideration the benign nature of the lesion and its size).

The mass was excised totally.  Biopsy was reported as rhinosporidiosis.

This picture shows the perforated septum

Here you will be seeing the surgical clipping of the patient











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