Disseminated cutaneous rhinosporidiosis
A 52-year-old man presented with multiple asymptomatic lesions on the right ear, right upper extremity and back since last 2 years. The patient also had nasal obstruction and difficulty in breathing for 4 years due to a nasal polyp, that were excised several times, only to recur every time. On examination, there were multiple verrucous papular and nodular lesions on right pinna [Figure 1]. Verrucous lesions were present on back and right forearm. A skin-colored deep-seated tumorous mass was present on the right arm. Right anterior nares revealed a reddish polypoid growth. Biopsy showed upper and mid dermal nodular dense tuberculoid and suppurative granulomatous infiltrate with multiple sporangia in various stages of maturation. A few mature thick-walled endospore filled sporangia were seen. Overlying epidermis had moderate spongiotic psoriasiform change. Periodic acid-Schiff stained sections were positive for these organisms. Based on clinicopathological correlation, a final diagnosis of disseminated cutaneous rhinosporidiosis was rendered. Patient was started on oral dapsone, verrucous lesions were excised by radiofrequency ablation and surgical referral was done for the tumorous lesion.