Verrucous and crusted plaques of rhinosporidiosis

A 70-year-old male presented with multiple raised lesions over the left side of the back for the past 2 years. Initially, the lesions were small to start with and gradually increased in size and number and attained the present size. There were no lesions elsewhere in the body including oral, nasal, and genital mucosa other than this site. He could not remember any history of trivial trauma. He had a habit of bathing in a common pool in his village. On dermatological examination, there were multiple verrucous and fragile exophytic growths of varying sizes over the left side of the back region unilaterally [Figure 1]. There were some skin-colored papules seen interspersed among them. These growths were crushed and examined under 10% potassium hydroxide [Figure 2]. It revealed multiple double-walled sporangia filled with sporangiospores suggestive of cutaneous rhinosporidiosis. Serology for human immunodeficiency virus 1 and 2 was done and turned non-reactive. Cutaneous rhinosporidiosis can present like verruca vulgaris, tuberculosis verrucosa cutis, granuloma pyogenicum, venereal warts, and donovanosis.^[1] This case was interesting due to the extensive distribution of cutaneous rhinosporidiosis in an immunocompetent male without any mucosal involvement.

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Figure 1:

Multiple pigmented verrucous lesions over back.

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Figure 2:

Multiple double-walled sporangia with sporangiospores seen under light microscopy (10 × 10 magnification).

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