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)