An Anesthesiologist’s Perspective of Disseminated Cutaneous Rhinosporidiosis: ‘Block Resection’ of the Lesions!

Abstract

Rhinosporidiosis is a chronic granulomatous disease caused by a fungus-like organism, Rhinosporidium seeberi, which is endemic in India and Sri Lanka. Polypoidal nasal mass is the most common clinical manifestation, with scattered case reports of lesions in the nasopharynx, eye (nasolacrimal duct) and lower aerodigestive tract. Isolated disseminated cutaneous lesions, though reported, are very rare. Purpose: This case report aims to throw light on the path less travelled - management of such a rare and challenging patient through the eyes of an anesthesiologist. Case: 36 year old ASA I male with disseminated cutaneous rhonosporidiosis for surgical excision of upper and lower limb lesions. Intravenous access was secured by central line. Anesthetic coverage for upper and lower limbs was provided with interscalene + supraclavicular block and subarachnoid block respectively. Conclusion: Chronic recurrent disseminated cutaneous rhinosporidiosis poses novel challenges for the anaesthesiologist in the perioperative period, right from simple issues such as intravenous access to the more pressing concern of choosing an anaesthetic technique tailored to the wide variety of clinical presentations and hence planned surgical interventions.