Histopathologically Confirmed Nasal Rhinosporidiosis in an Adolescent Male Presenting with Long-Standing Right-Sided Nasal Obstruction and Epistaxis: A Case Report

Fahma Aden Mohamed,1 Abdishakur Mohamed Karim,1 Geoffrey Tabu21Department of ENT, Kampala International University, Ishaka, Uganda; 2Department of ENT, Jinja Regional Referral Hospital, Jinja, UgandaCorrespondence: Fahma Aden Mohamed, Department of ENT, Kampala International University, Ishaka, Uganda, Email [email protected]: Rhinosporidiosis is a chronic granulomatous mucosal infection caused by Rhinosporidium seeberi, most commonly affecting the nasal cavity and nasopharynx. It typically presents as a friable polypoidal lesion associated with nasal obstruction and recurrent epistaxis. Histopathological examination is essential for definitive diagnosis.Case Presentation: A 17-year-old male presented with a five-year history of progressive right-sided nasal obstruction and recurrent epistaxis. The nasal mass gradually enlarged and eventually protruded through the right nostril. He reported repeated swimming and playing in a nearby pond before symptom onset. Baseline laboratory investigations showed a hemoglobin level of 13.9 g/dL, white blood cell count of 6.63 × 109/L, and platelet count of 345 × 109/L. Mean corpuscular volume was reduced at 76.2 fL. Computed tomography demonstrated a well-defined soft-tissue lesion occupying the right nasal cavity without obvious destructive bony erosion. The lesion was excised through a transnasal approach, followed by cauterization of its base. Histopathological examination demonstrated chronically inflamed subepithelial stroma containing numerous thick-walled sporangia filled with endospores, confirming nasal rhinosporidiosis. Sporangia were present at the resection margin, indicating incomplete histological clearance. Postoperatively, oral dapsone 100 mg once daily was commenced for a planned six-month course after confirmation of normal glucose-6-phosphate dehydrogenase status. At three-month follow-up, repeat computed tomography showed no radiological evidence of recurrence.Conclusion: Nasal rhinosporidiosis should be considered in patients with long-standing unilateral nasal obstruction, recurrent epistaxis, and pond-water exposure. Complete surgical excision with cauterization and continued postoperative surveillance are important, particularly when histological margins are involved.Keywords: rhinosporidiosis, nasal mass, epistaxis, unilateral nasal obstruction, histopathology, case report