A rare case of disseminated Rhinosporidiosis highlighting the need for specific management protocol

Rhinosporidiosis is a chronic, recurrent, infective, granulomatous disease of man and animals. It is endemic in Southern India and Sri Lanka. Rhinosporidiosis commonly involves the nose and the nasopharynx. Cutaneous lesions, although rare, can occur due to auto-inoculation or haematogenous spread; however lymphatic spread in the head and neck region has not been documented in the English literature. We document here an immuno-competent gentleman who had multiple, painless, cutaneous lesions secondary to primary nasal Rhinosporidiosis, presenting at different points in time over a period of 10 years and over various parts of the body. Histopathological examination revealed the spread of the fungal spores, through the lymphatic channels of the head and neck, to the upper cervical lymph nodes and the skin of the submandibular region, coupled with haematogenous spread to the lower limb. We have, accordingly, suggested need for a specific protocol for the management of Rhinosporidiosis.