Acquired cutaneous fistula in the periocular area: A case report

Abstract

BACKGROUND

Lacrimal sac rhinosporidiosis, with nil or minor nasal extensions, rarely presents as an acquired cutaneous fistula in the periocular area. The correct diagnosis in such cases can be challenging, leading to repeated failure of conservative or surgical interventions.

CASE SUMMARY

A 39-year-old female presented with a 6-year history of swelling in the periocular area, specifically in the left lacrimal sac area. Symptoms were limited to epiphora and constant mucoid discharge from the fistula, clinically mimicking chronic lacrimal sac fistula. She had a history of treatment with multiple antibiotic courses and dacryocystectomy in the past, with no or transient symptomatic relief. On surgical exploration of the site, a large pedunculated polypoidal vascular mass, suspicious of rhinosporidiosis, was noted. En bloc resection of the mass with cauterization of the base and fistulectomy was performed. Histopathology confirmed the diagnosis of lacrimal sac rhinosporidiosis. The patient was further evaluated and treated for the nasal extension of rhinosporidiosis. The patient has been frequently followed up for the last 3 years with a good clinical outcome and no recurrence.

CONCLUSION

Lacrimal sac rhinosporidiosis, in isolated or limited nasal extension cases, can rarely mimic a chronic discharging fistula. Patients with this disease often face distress due to misdiagnosis and repeated failure of conservative or surgical interventions. A high index of suspicion is needed for early diagnosis. Proper surgical intervention at the right time can lead to an excellent prognosis in such patients.

Keywords: Lacrimal sac fistula; Ocular rhinosporidiosis; Epiphora; Periocular area; Case report

Core Tip: Lacrimal sac rhinosporidiosis can rarely present as a chronic discharging fistula. We report the case of a 39-year-old female with a 6-year history of epiphora and mucoid discharge from a left lacrimal sac fistula, clinically mimicking chronic dacryocystitis. Surgical exploration revealed a large pedunculated vascular mass, which was confirmed on histopathology as lacrimal sac rhinosporidiosis. She was treated for nasal extension, remaining recurrence-free over 3 years of follow-up. This case highlights the importance of keeping rhinosporidiosis as a differential for any patient with lacrimal sac area swelling, with or without discharging fistula.