Rhinosporidiosis treatment — DTM&H MCQ

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ModerateTropical Bacterial InfectionsRhinosporidiosis treatmentDTM&H

A 25-year-old woman in northern Thailand presents with progressive painless nasal obstruction and epistaxis. Nasal endoscopy shows a large strawberry-like polypoidal mass in the nasal cavity. Biopsy shows chronic inflammatory tissue with thick-walled sporangia. What treatment is most appropriate?

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Correct answer: C — Surgical excision of the polypoidal mass

The correct answer is C, surgical excision of the polypoidal mass. The clinical picture (painless nasal obstruction, epistaxis, a strawberry-like polypoidal mass on endoscopy) combined with biopsy showing thick-walled sporangia is classic for rhinosporidiosis, caused by Rhinosporidium seeberi, endemic in South Asia and parts of Southeast Asia including Thailand. There is no reliably effective antimicrobial or antifungal agent that eradicates the organism, so definitive management is wide surgical excision of the mass with cauterisation of the base to reduce the risk of local recurrence. This approach remains the accepted mainstay across tropical medicine practice and is the standard taught in UK DTMH curricula for this condition. Why the other options are wrong: E. Amphotericin B intravenously: Rhinosporidium seeberi is not a fungus susceptible to antifungal agents; it is now classified separately (an aquatic protistan parasite), so amphotericin B has no proven efficacy. A. Intranasal corticosteroids: these treat inflammatory or allergic rhinosinusitis and nasal polyps of allergic origin, not a granulomatous infectious mass containing sporangia, and will not resolve the lesion or prevent bleeding. B. Oral itraconazole for 6 months: itraconazole is an antifungal and rhinosporidiosis is not a true fungal infection; no oral antimicrobial regimen has demonstrated reliable cure or prevention of recurrence. D. Radiotherapy: radiotherapy has no established role in rhinosporidiosis, carries unnecessary toxicity, and is not supported by any evidence base for this benign, locally destructive lesion. Key point: Rhinosporidiosis has no effective medical cure, so wide surgical excision with cauterisation of the base is the definitive treatment of choice.

Reference: Das S et al., Recurrent nasopharyngeal rhinosporidiosis: Case report and review of the literature, PMC7355714 (2020); management principles also reflected in UK DTMH tropical medicine teaching on rhinosporidiosis. https://pmc.ncbi.nlm.nih.gov/articles/PMC7355714/