A 32-year-old farmer from rural Maharashtra presents with a recurrent pinkish-red, lobulated, sessile mass on the nasal septum that bleeds profusely on touch. Biopsy shows large sporangia filled with endospores beneath the epithelium. The causative agent is:

• A Mycobacterium tuberculosis
• B Rhizopus arrhizus
• C Aspergillus flavus
• D Rhinosporidium seeberi ✓

Explanation

Rhinosporidiosis, caused by Rhinosporidium seeberi, an aquatic protistan parasite historically mistaken for a fungus, is endemic in India and Sri Lanka and linked to bathing in stagnant water. It forms vascular, friable, strawberry-like polyps on the septum or inferior turbinate that bleed easily, and histology shows thick-walled sporangia containing numerous endospores. Rhizopus causes angioinvasive mucormycosis, Aspergillus causes fungal balls and allergic disease, and tuberculosis produces granulomas with caseation, none of which show sporangia.

Reference: Dhingra's Diseases of Ear, Nose and Throat, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.