Case presentation
We are presenting an 11-year old male boy who presented at our
outpatient otorhinolaryngology clinic at Benjamin Mkapa Hospital with a
2-years history of right-sided nasal obstruction and intermittent
epistaxis for 2 years. He had no history of cheek pain, numbness of the
cheek, loss of teeth, loosening of teeth or alveolar ridge fullness. No
ophthalmological, otological or neurological complaints were reported
upon enquiry.
On physical examination, the patient was found to have a right-sided
friable nasal mass filling the entire nasal cavity and had no nasal
deformity externally. He was not pale and had no palpable peripheral
lymph nodes. Ophthalmological, otological and neurological evaluation
revealed normal findings. Laboratory results showed hemoglobin 12g/dl
and elevated ESR (40mm/hour). A provisional diagnosis of pyogenic
granuloma was established and the patient was sent for endoscopic
surgical nasal mass excision under general anaesthesia and the excised
specimen was sent for histopathology. Histopathological analysis
revealed thick-walled sporangium containing numerous endospores
(daughter spores) (Figure 1) and with further sections showing thick
walled sporangium with endospores in different stages of development
accompanied by a mixed inflammatory cells mainly plasma cells and
lymphocytes (Figure 2).
Figure 1: Intermediate power view of thick-walled sporangium
containing numerous endospores (daughter spores)