Cryptococcal infection range from asymptomatic pulmonary colonization to life-threatening meningitis.12. Laryngeal cryptococcal infections are exceedingly rare.
A 55-year-old man was evaluated for hoarseness and worsening cough of 6 weeks’ duration. His past medical history was notable for asthma, allergic fungal sinusitis, and sinus surgery. His medications included inhaled albuterol, and flunisolide. He also had stopped using fluticasone nasal spray recently. His physical examination was unremarkable, except for a patch of leukoplakia on the right anterior vocal cord with erythema of the entire right vocal cord noted on fiberoptic endoscopy. Biopsy of the right vocal cord lesion was performed. GMS stain of the biopsy specimen revealed the fungal organisms with morphologic features of Cryptococcus Neoformans and the fungal culture grew Cryptococcus Neoformans. Evaluation for cryptococcal dissemination was negative.Patient was treated by itraconazole 200 mg twice daily for 6 weeks followed by fluconazole 400 mg a day for 10 additional weeks. Patient was disease-free at the end of the treatment course and at 10-month follow-up visit.DISCUSSION: Our case represents the sixth case of laryngeal cryptococcal infection in the literature.The most common presenting symptom among these cases was hoarseness and only one patient required tracheostomy3. In general, antifungal therapy is recommended for most patients with cryptococcal infections, especially those patients who are immunocompromised.CONCLUSIONS: Cryptococcal laryngeal infection is rare but it should be considered in the differential diagnosis of persistent hoarseness occurring in an immunocompromised subject. Inhaled corticosteroid therapy may be a predisposing factor for cryptococcal laryngitis in non-immunocompromised subjects.
H.F. Nadrous, None.