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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 60  |  Issue : 3  |  Page : 269-271

A rare case report of oculosporidiosis from South India: 'Fish Egg' appearance means a lot


1 Medical Consultant, Department of Cornea & Refractive Surgery Services, Aravind Eye Hospital, Madurai, India
2 Chief Medical Office, Aravind Eye Hospital, Theni, India
3 Consultant, Aravind Eye Hospital, Theni, India
4 Fellow in the Department of Glaucoma Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
5 Head, Department of Ocular Pathology, Aravind Eye Hospital, Madurai, Tamil Nadu, India

Date of Submission20-Oct-2021
Date of Decision20-Apr-2022
Date of Acceptance24-Apr-2022
Date of Web Publication26-Sep-2022

Correspondence Address:
Vishnu Teja Gonugunta
Department of Cornea and Refractive Surgery Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, 1, Anna nagar, Madurai - 625 020, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_160_21

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  Abstract 


To emphasise the importance and possibility of a rare infective condition caused by Rhinosporidium seeberi presented with a vascular mass. A 50-year-old male presented with complaints of a recently noted red mass in his left eye causing irritation. Ocular examination revealed the presence of a large, red vascular mass with numerous greyish-white spots (Fish egg-like appearance) on its surface with feeder vessels. A provisional diagnosis of conjunctival hemangioma was made and planned for excision. The mass was excised and sent for biopsy. It did not require grafting. Histopathological examination revealed a structure of polypoidal mucosal inflammation studded with multiple double-walled sporangia containing endospores in a swiss cheese pattern suggestive of rhinosporidiosis. Rhinology consultation was normal. No recurrence is noted during the follow-up period of 18 months. Bulbar conjunctival involvement is relatively rare. 'Fish egg' appearance aids in the diagnosis and histopathology confirms it. Excision is the only treatment.

Keywords: Conjunctival mass, oculosporidiosis, rhinosporidiosis, Rhinosporidium seeberi


How to cite this article:
Gonugunta VT, Dipankar D, Sujatha T S, Kuppuraj D, Pabolu C, Radhakrishnan SD. A rare case report of oculosporidiosis from South India: 'Fish Egg' appearance means a lot. TNOA J Ophthalmic Sci Res 2022;60:269-71

How to cite this URL:
Gonugunta VT, Dipankar D, Sujatha T S, Kuppuraj D, Pabolu C, Radhakrishnan SD. A rare case report of oculosporidiosis from South India: 'Fish Egg' appearance means a lot. TNOA J Ophthalmic Sci Res [serial online] 2022 [cited 2022 Dec 10];60:269-71. Available from: https://www.tnoajosr.com/text.asp?2022/60/3/269/357108



A 50-year-old male who is a fisherman by occupation had presented to our hospital with complaints of recent onset of a reddish mass in his left eye associated with irritation. No history of ocular trauma or ocular surgery was noted in the left eye before. His visual acuity for distance is 6/6 in both eyes. His ocular examination was within normal limits in both eyes except for the presence of a large 8 × 6 mm oval, pedunculated, soft, red vascular mass, 2 mm in thickness with well-defined margins lying over the superotemporal bulbar conjunctiva and overhanging 2 mm onto the cornea with numerous greyish-white spots ('Fish egg' like appearance) on its surface with feeder vessels in the left eye [Figure 1]. A provisional diagnosis of conjunctival hemangioma was made and planned for excision biopsy. Under topical anesthesia, the feeder vessels were electro cauterized and the conjunctiva surrounding the pedicle of the mass was cut and finally, the pedicle of the mass was cut from its base and separated off the underlying episclera [Figure 2]. Minimal bleeding was noted which got arrested with electrocautery. The conjunctival defect thus formed was small and did not require graft transplantation. Topical Povidone-Iodine drops 5% w/v drops (Aurodone, manufactured by Aurolab, India) was applied at the end of the surgery. Postoperatively, ofloxacin 0.3% eye drops was advised four times a day for 10 days. Histopathological examination with haematoxylin and eosin stain revealed polypoidal mucosal inflammation studded with multiple double walled sporangia containing endospores in swiss cheese pattern suggestive of rhinosporidiosis [Figure 3]. Rhinology consultation was sought and it was found to be normal. The patient was followed up postoperatively on day 1, day 30, 3 months, 6 months and 18 months. No recurrence was noted during the follow up period of 18 months [Figure 4]. Rhinosporidiosis is an infection of the mucosal surfaces of humans or animals with Rhinosporidium seeberi, a microorganism that was considered a fungus and is now considered a protist classified under Mesomycetozoa.[1] One of the risk factors is exposure to pond water. The microorganism mostly affects the mucosa of the nasal cavity followed by the nasopharynx, and eye in humans.[2] Isolated infection of the eye with R. seeberi is rare (oculosporidiosis). In the eye, the conjunctiva is the most commonly affected site, but the lacrimal gland, lid and sclera may also be affected.[3],[4] Isolated ocular involvement of bulbar conjunctiva is less common than tarsal conjunctiva.[5] The microorganisms proliferate in the sporangia of the affected site. Surgical excision is the only treatment of choice. Good results with least recurrence are noted with excision of the mass in cases of conjunctival involvement. The greyish-white dots on the red fleshy mass which gives a fish egg-like appearance correspond to the mature sporangia and aid in the clinical diagnosis.[6] The occupation of our patient being a fisherman thus more prone to get exposed to natural habitat water is a further risk factor for Rhinosporidium to be the causative organism.[7] Histopathological examination confirms the diagnosis. Surgical intervention is the only treatment of choice. Routine use of povidone iodine 5% after excision of the growth is proven useful. Arseculeratne et al.[8] have reported metabolic inactivation of endospores on exposure to certain biocides including povidone iodine. This might prevent the recurrence of the disease due to auto-inoculation of the endospores contaminating the adjacent mucosal surfaces during surgery. The organism, Rhinosporidium has also been reported to affect skin and bones apart from sites mentioned by the authors. It has also been noted that in long-standing extensive involvement of the lacrimal sac, the surrounding bones may get eroded. The patients can be warned of the possible ocular infections associated with their exposure to the natural habitat water like ponds and the precautions to be taken to avoid the infections in various parts of the body.
Figure 1: Clinical appearance of Oculosporidiosis with vascular mass with greyish white dots with feeder vessels

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Figure 2: Excision of the mass from its pedicle

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Figure 3: Haematoxylin and eosin staining shows multiple double walled sporangia containing endopsores in swiss cheese pattern

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Figure 4: No recurrence at 18 months postoperative follow-up

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Morelli L, Polce M, Piscioli F, Del Nonno F, Covello R, Brenna A, et al. Human nasal rhinosporidiosis: An Italian case report. Diagn Pathol 2006;1:25.  Back to cited text no. 1
    
2.
Sudarshan V, Goel NK, Gahine R, Krishnani C. Rhinosporidiosis in Raipur, Chhattisgarh: A report of 462 cases. Indian J Pathol Microbiol 2007;50:718-21.  Back to cited text no. 2
[PUBMED]    
3.
Sood NN, Rao SN. Rhinosporidium granuloma of the conjunctiva. Br J Ophthalmol 1967;51:61-4.  Back to cited text no. 3
    
4.
Pal N, Adhikary M, Chatterjee RN, Majhi B. Conjunctival oculosporidiosis: A case report from a nonendemic zone in India. Arch Med Health Sci 2016;4:72-4.  Back to cited text no. 4
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5.
Kuriakose ET. Oculosporidiosis: Rhinosporidiosis of the eye. Br J Ophthalmol 1963;47:346-9.  Back to cited text no. 5
    
6.
Mukhopadhyay S, Datta H, Sen D. Intracorneal rhinosporidiosis managed with deep anterior lamellar keratoplasty. Middle East Afr J Ophthalmol 2014;21:361-2.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Jain SN. Aetiology and incidence of rhinosporidiosis. Ind J Otol 1967;19:1-21.  Back to cited text no. 7
    
8.
Arseculeratne SN, Atapattu DN, Balasooriya P, Fernando R. The effects of biocides (antiseptics and disinfectants) on the endospores of Rhinosporidium seeberi. Indian J Med Microbiol 2006;24:85-91.  Back to cited text no. 8
[PUBMED]  [Full text]  


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