rhinosporidiosis is a chronic granulomatous infection caused by rhinosporidium seeberi is endemic in india and in sri lanka but has also been reported from united states , south america and iran . rhinosporidiosis frequently involves the nasopharynx ( 70% ) presenting as painless , friable , polypoidal growth which may hang anteriorly into the nares and posteriorly into the pharynx . this disease presents to dermatologists and ophthalmologists with the cutaneous , subcutaneous and ocular lesions . they commonly manifest as a sessile or pedunculated vascular polyp in nasal mucosa , nasopharynx and soft palate . the cutaneous lesions without mucosal involvement are extremely rare and they presents as asymptomatic warty growth . a 46-year- old man presented with multiple cutaneous lesions over the face & back [ figures 1 and   2 ] with mass in the oral cavity since 1 year . he had nasal obstruction , mouth breathing since 4 years . on examination , cutaneous lesions were present on malar aspect , infraorbital region , supraorbital region , right shoulder and over the back near the tip of scapula . lesions were progressively increasing in size and were painless , plaque like with no discharge . polypoidal lesion was found to be present in the base of tongue which moved with deglutition [ figure 3 ] . his complete hemogram , blood sugar , liver and renal functions tests were within normal limits . excision biopsy from cutaneous lesions and pharyngeal mass was sent for histopathology in 10% formalin . on gross , there were multiple grey white tissue bits ; few were polypoidal in nature , larger one measuring 2.511cms . microscopy showed hyperplasic epithelium , with numerous globular cysts of varying sizes representing immature and few mature sporangia in the upper dermis . there was infiltration by chronic inflammatory cells and ruptured sporangia with release of endospores with giant cell reaction [ figure 4 ] . plaque like lesions over the face nodular lesion over the back polypoidal lesion at the base of the tongue cutaneous rhinosporidiosis with immature sporangia and giant cell reaction it is an aquatic protozoan and recent taxonomy suggests it is in a new eukaryotic group of protists known as mesomycetozoa . ahluwalia et al suggested the cyanobacterium microcystis aeruginosa as the causative agent for rhinosporidiosis , which has been isolated from clinical samples as well as from the water samples in which patients take bathing . the infection affects nasal mucosa , ocular conjunctiva of human and animals producing slowly growing masses with pink to purple , friable polyps . disease can manifest in four forms i.e,- nasal , ocular , cutaneous and disseminated ( rare ) . infection of nose and nasopharynx is observed in majority , while infection of the palpebral conjunctiva or associated structures like the lacrimal apparatus is observed in 15% . cutaneous lesions are infrequent and are generally associated with mucosal lesions . in our case , shenoy et al reported a similar case of disseminated cutaneous rhinosporidiosis along with nasopharyngeal the lesion . a case of disseminated cutaneous rhinosporidiosis in an hiv- positive patient also has been described . development of a cutaneous lesion may be an indication of early dissemination and thorough search should be made to exclude systemic involvement . several modes of spread have been postulated for cutaneous rhinosporidiosis like autoinoculation , hematogenous spread , direct inoculation and lymphatic spread leading to disseminated cutaneous lesions . surgical removal and diathermy excision is the treatment of choice , but still recurrence is common . several drugs such as dapsone , ketoconazole , ciprofloxacin and amphotericin b have been tried but dapsone is quite effective . this case highlights the rare occurrence of disseminated cutaneous rhinosporidiosis , the possibility of which should be kept in mind particularly when cutaneous lesions are associated with pharyngeal lesions .
rhinosporidiosis is a granulomatous disorder caused by rhinosporidium seeberi . 
 it frequently involves the nasopharynx and occasionally affects the skin . 
 we hereby report a case of 46year - old male who presented with multiple cutaneous plaque - like lesions with nasal obstruction . on examination , 
 multiple cutaneous lesions were found to be present on malar aspect , infraorbital and supraorbital region , right shoulder and over the back near the tip of scapula . 
 oral cavity revealed a polypoidal lesion , in the base of the tongue . 
 excision biopsy confirmed the lesions as disseminated cutaneous rhinosporidiosis . 
 the patient was treated with excision and dapsone therapy . 
 after 1 year of therapy , the patient has disease - free survival . 
 we report this rare case of rhinosporidiosis with disseminated cutaneous involvement .